Individual provider Active NPI

Lori Ann Colyer-Aversa, M.D.

  • Pediatrics Physician
  • Bloomfield, NJ
National Provider Identifier
1376582734
Registry record updated Aug 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
25MA5801100 Issued in NJ
Practice address
1310 Broad St Unit B
Bloomfield, NJ 07003-3010
Phone
(973) 748-9500
Fax
(973) 748-9492
NPI assigned
Jun 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 25MA5801100 NJ Primary

Addresses

Primary practice location

1310 Broad St Unit B
Bloomfield, NJ 07003-3010

Mailing address

PO Box 95000
Philadelphia, PA 19195-7550
Phone (844) 362-1735

Other identifiers 1

IdentifierTypeStateIssuer
5553903-01MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151201000174 NJ Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 6103126982

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA58011NJMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care Partners LLC Pediatrics Past Accepting new patients
Primary Care Partners, LLC Pediatrics Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786406400000",
    "number": "1376582734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95000",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191957550",
            "telephone_number": "844-362-1735",
            "fax_number": "973-290-7495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 BROAD ST UNIT B",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070033010",
            "telephone_number": "973-748-9500",
            "fax_number": "973-748-9492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLYER-AVERSA",
        "first_name": "LORI",
        "middle_name": "ANN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-04",
        "last_updated": "2026-08-11",
        "certification_date": "2026-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA5801100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5553903-01",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomfield, NJ

Sources for this page

Verify at the official NPI Registry.