Provider Demographics
NPI:1831634674
Name:FIORENTINO, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FIORENTINO
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 1:3121 FIRE RD
Mailing Address - Street 2:STE.D-106
Mailing Address - City:EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-9619
Mailing Address - Country:US
Mailing Address - Phone:609-653-2422
Mailing Address - Fax:609-653-2422
Practice Address - Street 1:135 THOMPSON LN
Practice Address - Street 2:APT. 47
Practice Address - City:EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08234-7026
Practice Address - Country:US
Practice Address - Phone:609-653-2422
Practice Address - Fax:609-653-2422
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker