Provider Demographics
NPI:1811901903
Name:SHULTZ, LISA ANN (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:SHULTZ
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 1:396 WHITE HORSE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-1431
Mailing Address - Country:US
Mailing Address - Phone:609-585-0118
Mailing Address - Fax:609-585-0244
Practice Address - Street 1:396 WHITE HORSE AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-1431
Practice Address - Country:US
Practice Address - Phone:609-585-0118
Practice Address - Fax:609-585-0244
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA077094002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I13767Medicare UPIN
082160Medicare ID - Type Unspecified