Provider Demographics
NPI:1720206949
Name:SIRKIN, LISA M (BS PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:SIRKIN
Suffix:
Gender:F
Credentials:BS PT
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:CLAUSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS PT
Mailing Address - Street 1:44 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1434
Mailing Address - Country:US
Mailing Address - Phone:201-679-5061
Mailing Address - Fax:
Practice Address - Street 1:388 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1814
Practice Address - Country:US
Practice Address - Phone:973-228-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQAO6238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist