Individual
LORI ANN COLYER-AVERSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
399 HOOVER AVE, SUITE 5, BLOOMFIELD, NJ 07003-3924
(973) 748-9500
(973) 748-9492
Mailing address
LB 7550 PO BOX 95000, PHILADEPHIA, PA 19195-7550
(844) 362-1735
(973) 290-7495
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
25MA58011
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5553903-01
—
NJ
Enumeration date
06/04/2006
Last updated
12/12/2017
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