Provider Demographics
NPI:1437101623
Name:RINK, LISA A (DO)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:RINK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1338
Mailing Address - Street 2:
Mailing Address - City:BELLMAWR
Mailing Address - State:NJ
Mailing Address - Zip Code:08099-5338
Mailing Address - Country:US
Mailing Address - Phone:856-229-2217
Mailing Address - Fax:856-672-9111
Practice Address - Street 1:217 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1703
Practice Address - Country:US
Practice Address - Phone:856-572-1115
Practice Address - Fax:856-672-9111
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06921100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8063109Medicaid
NJ032213S6YMedicare ID - Type Unspecified
NJH00071Medicare UPIN