Provider Demographics
NPI:1629255666
Name:HAUER, LISA (DPM)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:HAUER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07063-1000
Mailing Address - Country:US
Mailing Address - Phone:908-753-6401
Mailing Address - Fax:973-669-8699
Practice Address - Street 1:1700 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07063-1000
Practice Address - Country:US
Practice Address - Phone:908-753-6401
Practice Address - Fax:973-669-8699
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00294700213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery