Provider Demographics
NPI:1659388858
Name:JORDAN-SCALIA, LISA J (DO)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:J
Last Name:JORDAN-SCALIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 US HIGHWAY 202
Mailing Address - Street 2:
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869
Mailing Address - Country:US
Mailing Address - Phone:908-253-6640
Mailing Address - Fax:908-253-6908
Practice Address - Street 1:901 US HIGHWAY 202
Practice Address - Street 2:
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869
Practice Address - Country:US
Practice Address - Phone:908-253-6640
Practice Address - Fax:908-253-6908
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB68586207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H16929Medicare UPIN
038254Medicare ID - Type Unspecified