Provider Demographics
NPI:1912373721
Name:LERNER, ELYSSE (APN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ELYSSE
Middle Name:
Last Name:LERNER
Suffix:
Gender:F
Credentials:APN, FNP-BC
Other - Prefix:MRS
Other - First Name:ELYSSE
Other - Middle Name:
Other - Last Name:KORNBLUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:144 COLES WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4885
Mailing Address - Country:US
Mailing Address - Phone:845-901-7289
Mailing Address - Fax:
Practice Address - Street 1:886 RIVER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5282
Practice Address - Country:US
Practice Address - Phone:732-523-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-15
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00583600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily