Provider Demographics
NPI:1932282894
Name:LISING, LIBRADA L (MD)
Entity Type:Individual
Prefix:DR
First Name:LIBRADA
Middle Name:L
Last Name:LISING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:15 WINDSOR CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-1228
Mailing Address - Country:US
Mailing Address - Phone:973-885-8669
Mailing Address - Fax:973-470-3506
Practice Address - Street 1:211 PENNINGTON AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4617
Practice Address - Country:US
Practice Address - Phone:973-470-3000
Practice Address - Fax:973-470-3506
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03038200207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6641806Medicaid
NJ6641806Medicaid
NJD06566Medicare UPIN