Provider Demographics
NPI:1225610272
Name:HAROOTUNIAN, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HAROOTUNIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CARMITA AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1124
Mailing Address - Country:US
Mailing Address - Phone:201-896-0563
Mailing Address - Fax:
Practice Address - Street 1:1199 PLEASANT VALLEY WAY
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1424
Practice Address - Country:US
Practice Address - Phone:973-414-4755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2025-07-28
Deactivation Date:2021-10-17
Deactivation Code:
Reactivation Date:2025-07-28
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02342500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist