Individual
LISA M MICIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1 W RIDGEWOOD AVE, SUITE 103, PARAMUS, NJ 07652-2359
(201) 857-4200
(201) 857-4199
Mailing address
1 W RIDGEWOOD AVE STE 103, PARAMUS, NJ 07652-2361
(201) 857-4200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
010318
NY
363A00000X
Physician Assistant
Primary
MP00136000
NJ
Other
Enumeration date
08/09/2006
Last updated
06/17/2014
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