Individual
MR. JUSTIN MICHAEL LIDDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1400 MACARTHUR BLVD, MAHWAH, NJ 07430-3618
(201) 316-8431
(201) 962-9735
Mailing address
716 WILSON CT, RIVER VALE, NJ 07675-6345
(201) 664-2597
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00500100
NJ
Other
Enumeration date
11/26/2018
Last updated
11/26/2018
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