Lisa Blankenship, OTR

Primary specialty

SpecialistTaxonomy code 174400000X

License

46TR00330700 Issued in NJ

Practice address

50 E Gloucester Pike
Barrington, NJ 08007-1323

Phone

(856) 547-4422

Fax

(856) 547-0660

NPI assigned

Oct 6, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Lisa Mollo Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164519617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 WEDGEWOOD DR",
            "city": "BLACKWOOD",
            "state": "NJ",
            "postal_code": "080121528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 E GLOUCESTER PIKE",
            "city": "BARRINGTON",
            "state": "NJ",
            "postal_code": "080071323",
            "telephone_number": "856-547-4422",
            "fax_number": "856-547-0660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANKENSHIP",
        "first_name": "LISA",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "46TR00330700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITEDHEALTHCARE MPIN",
            "identifier": "2318159",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "1525535",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PPO",
            "identifier": "6889635",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "MOLLO",
            "credential": "OTR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Barrington Dental Associates LLC
• Melody Bauer, BCBA
• Grace Olivia Bealor
• Melissa Benenfeld, DC
• Jennifer Susan Black
• Aisha Najuma Boddie-Willis, NP
• Monica P Bonitatis
• Cinzia Bonomo, PHARM. D.
• Brittany Borgese, BCBA
• Linda Joan Bornstein, OD

• All providers in Barrington, NJ
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.