Individual
ORA LISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
140 FRANKLIN TPKE, WALDWICK, NJ 07463-1847
(866) 722-3338
Mailing address
341 HERRICK AVE, TEANECK, NJ 07666-3103
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25MP00748900
NJ
Other
Enumeration date
12/15/2021
Last updated
09/09/2024
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