Provider Demographics
NPI:1679785786
Name:MORTON, LISA ASENI (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ASENI
Last Name:MORTON
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 1:403 US HIGHWAY 202
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-6037
Mailing Address - Country:US
Mailing Address - Phone:908-782-9123
Mailing Address - Fax:
Practice Address - Street 1:403 US HIGHWAY 202
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-6037
Practice Address - Country:US
Practice Address - Phone:908-782-9123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07388000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ057539PR2Medicare ID - Type Unspecified
NJH59926Medicare UPIN