Provider Demographics
NPI:1669936878
Name:GEORGE, LISA (APN)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BOWFELL CT
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2144
Mailing Address - Country:US
Mailing Address - Phone:201-841-9987
Mailing Address - Fax:
Practice Address - Street 1:435 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-2760
Practice Address - Country:US
Practice Address - Phone:201-217-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00574700207V00000X, 364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's HealthGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty