Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MA61031 | NJ |
NPI | 1285778449 |
---|---|
Provider Name | Dr. Lisa Caroline Vecchio |
First Address | South Orange, NJ 07079-2887 |
Second Address | South Orange, NJ 07079-2887 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6341802 | (05) | NJ |
GO2136 | (02) | NJ |