Provider Demographics
NPI:1649354119
Name:LIRA, LORRAINE (MD)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:LIRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 KINDERKAMACK RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1600
Mailing Address - Country:US
Mailing Address - Phone:201-261-6222
Mailing Address - Fax:201-261-4411
Practice Address - Street 1:99 KINDERKAMACK RD STE 307
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3021
Practice Address - Country:US
Practice Address - Phone:201-261-6222
Practice Address - Fax:201-261-4411
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA712622084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1K7882OtherHEALTHNET
NJ8719209Medicaid
9059043-002OtherCIGNA
P2533299OtherOXFORD
NJ8719209Medicaid
G35524Medicare UPIN
130024072Medicare ID - Type UnspecifiedRAILROAD