Provider Demographics
NPI:1770142770
Name:FARRINGTON-RANKINS, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FARRINGTON-RANKINS
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 1:1200 US HIGHWAY 22 STE 2000
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2943
Mailing Address - Country:US
Mailing Address - Phone:908-203-4632
Mailing Address - Fax:908-725-0296
Practice Address - Street 1:1200 US HIGHWAY 22 STE 2000
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807
Practice Address - Country:US
Practice Address - Phone:908-203-4632
Practice Address - Fax:908-725-0296
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0450387882171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1770142770Medicaid