Provider Demographics
NPI:1184606329
Name:BRAND-ABEND, LORI M (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:M
Last Name:BRAND-ABEND
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 1:35 OLCOTT SQ
Mailing Address - Street 2:
Mailing Address - City:BERNARDSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07924-2326
Mailing Address - Country:US
Mailing Address - Phone:908-766-2730
Mailing Address - Fax:
Practice Address - Street 1:35 OLCOTT SQ
Practice Address - Street 2:
Practice Address - City:BERNARDSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07924-2326
Practice Address - Country:US
Practice Address - Phone:908-766-2730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA053005002085R0202X, 2085B0100X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02197111Medicaid
NJ6085105Medicaid
G21734Medicare UPIN
NJ835458Medicare PIN