Provider Demographics
NPI:1659302925
Name:FERRARO, LISA (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FERRARO
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 1:414 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-2105
Mailing Address - Country:US
Mailing Address - Phone:973-742-1761
Mailing Address - Fax:973-742-2033
Practice Address - Street 1:414 BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-2105
Practice Address - Country:US
Practice Address - Phone:973-742-1761
Practice Address - Fax:973-742-2033
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA050972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ398184OtherWELLCARE
NJ223425594OtherHORIZON PROVIDER ID NUMBE
NJJ6378OtherHORIZON HMO BLUE PROVIDER
NJ1658905Medicaid
NJ5187199002OtherCIGNA HEALTH PLAN
NJ01095174OtherAMERIGROUP
NJ2864054001OtherAMERIHEALTH
NJ90000300700OtherAMERICHOICE
NJ29EB21OtherWELL CHOICE PROVIDER NUMB
NJPP188OtherOXFORD PROVIDER NUMBER
NJ595703OtherAETNA PROVIDER NUMBER
NJ25MA05097200ANEOtherHEALTHFIRST
NJ511952OtherUNITED HEALTHCARE
NJ713681OtherHEALTH NET PROVIDER NUMBE
NJ398184OtherWELLCARE
NJ453471DLQMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER