Provider Demographics
NPI:1700902079
Name:KOTLER, LISA ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE
Last Name:KOTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:411 HACKENSACK AVE
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6328
Mailing Address - Country:US
Mailing Address - Phone:201-465-8111
Mailing Address - Fax:201-465-8110
Practice Address - Street 1:411 HACKENSACK AVE
Practice Address - Street 2:7TH FLOOR
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6328
Practice Address - Country:US
Practice Address - Phone:201-465-8111
Practice Address - Fax:201-465-8110
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1980202084P0804X
NJ25 MA 720932084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYHO5684Medicare UPIN