Provider Demographics
NPI:1700483146
Name:BAIOCCHI, LISA DAWN
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN
Last Name:BAIOCCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 E PHOENIX AVE # A
Mailing Address - Street 2:
Mailing Address - City:LAWNSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08045-1523
Mailing Address - Country:US
Mailing Address - Phone:856-546-6464
Mailing Address - Fax:856-547-1913
Practice Address - Street 1:37 E PHOENIX AVE
Practice Address - Street 2:
Practice Address - City:LAWNSIDE
Practice Address - State:NJ
Practice Address - Zip Code:08045-1523
Practice Address - Country:US
Practice Address - Phone:856-546-6454
Practice Address - Fax:856-547-1931
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide