Provider Demographics
NPI:1689645962
Name:LIESER, JOAN KAREN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:KAREN
Last Name:LIESER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 WOODBRIDGE CTR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-1150
Mailing Address - Country:US
Mailing Address - Phone:732-636-6622
Mailing Address - Fax:732-636-3669
Practice Address - Street 1:1 WOODBRIDGE CTR
Practice Address - Street 2:SUITE 400
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-1150
Practice Address - Country:US
Practice Address - Phone:732-636-6622
Practice Address - Fax:732-636-3669
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA51953207V00000X
NJ25MA05195300207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4578708Medicaid
NJF39262Medicare UPIN
NJ4578708Medicaid