Provider Demographics
NPI:1598919250
Name:DEANNUNTIS, LIZA LELUJA (MD)
Entity Type:Individual
Prefix:DR
First Name:LIZA
Middle Name:LELUJA
Last Name:DEANNUNTIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GEORGE BELLOWS WAY
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-7222
Mailing Address - Country:US
Mailing Address - Phone:856-753-5153
Mailing Address - Fax:949-223-6995
Practice Address - Street 1:4 GEORGE BELLOWS WAY
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-7222
Practice Address - Country:US
Practice Address - Phone:856-753-5153
Practice Address - Fax:949-223-6995
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA065384207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine