Provider Demographics
NPI:1437976974
Name:DONOFRI, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DONOFRI
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 1:25 TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3630
Mailing Address - Country:US
Mailing Address - Phone:732-841-4634
Mailing Address - Fax:
Practice Address - Street 1:3322 US HIGHWAY 22 W
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3476
Practice Address - Country:US
Practice Address - Phone:732-474-8700
Practice Address - Fax:732-474-7437
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11847541502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry