Provider Demographics
NPI:1659306058
Name:FORZANI, LISA (DC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FORZANI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 HIGHWAY 35
Mailing Address - Street 2:SUITE 5 1ST FLOOR
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719
Mailing Address - Country:US
Mailing Address - Phone:732-974-9100
Mailing Address - Fax:732-974-7964
Practice Address - Street 1:1930 HIGHWAY 35
Practice Address - Street 2:SUITE 5 1ST FLOOR
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719
Practice Address - Country:US
Practice Address - Phone:732-974-9100
Practice Address - Fax:732-974-7964
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00425500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U42699Medicare UPIN
F031639Medicare ID - Type Unspecified