Provider Demographics
NPI:1427097526
Name:FALCON, LISA F (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:F
Last Name:FALCON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 POLKTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08827-4007
Mailing Address - Country:US
Mailing Address - Phone:908-310-6046
Mailing Address - Fax:
Practice Address - Street 1:312 WALTER E FORAN BLVD
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4663
Practice Address - Country:US
Practice Address - Phone:908-782-4700
Practice Address - Fax:908-782-3785
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA043977002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD92096Medicare UPIN
NJ609612Medicare ID - Type Unspecified