Provider Demographics
NPI:1932360823
Name:ALLEN, LISA R (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:WEISFELNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2 CAPITAL WAY
Mailing Address - Street 2:SUITE 505
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08648
Mailing Address - Country:US
Mailing Address - Phone:609-537-6700
Mailing Address - Fax:609-537-6717
Practice Address - Street 1:633 3RD AVE FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6943
Practice Address - Country:US
Practice Address - Phone:646-227-3764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09146600208600000X
PAMT185965208600000X
TXN8880208600000X
PAMD434543208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281530001 (MDACC)Medicaid
TXP01037364OtherRR MEDICARE (MDACC)
TX8CW159OtherBCBS (MDACC)
TX281530001 (MDACC)Medicaid