Provider Demographics
NPI:1841777976
Name:PAUL, LISA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E TAUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-1622
Mailing Address - Country:US
Mailing Address - Phone:856-767-0320
Mailing Address - Fax:856-760-1080
Practice Address - Street 1:15 E TAUNTON AVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-1622
Practice Address - Country:US
Practice Address - Phone:856-767-0320
Practice Address - Fax:856-768-1080
Is Sole Proprietor?:No
Enumeration Date:2018-07-21
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00821600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1841777976Medicaid