Organization
LISA CANNON MD FCCP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA M CANNON MD (OWNER)
(201) 251-2525
Entity
Organization
Contact information
Practice address
110 WARREN AVE, HO HO KUS, NJ 07423-1566
(201) 251-2525
Mailing address
PO BOX 158, WYCKOFF, NJ 07481-0158
(201) 251-2525
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA69017
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3344304
—
NJ
Enumeration date
05/23/2006
Last updated
11/02/2007
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