Active NPI
Lisa Cannon MD FCCP
- Specialist
- Ho Ho Kus, NJ
National Provider Identifier
1558316315
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA69017
- Legal business name
- LISA CANNON MD FCCP
- Practice address
- 110 Warren Ave
Ho Ho Kus, NJ 07423-1566 - Phone
- (201) 251-2525
- NPI assigned
- May 23, 2006
- Last updated
- Nov 2, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Lisa M Cannon, MD
- Title
- Owner
- Phone
- (201) 251-2525
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA69017 | NJ | Primary |
Addresses
Primary practice location
110 Warren Ave
Ho Ho Kus, NJ 07423-1566
Mailing address
PO Box 158
Wyckoff, NJ 07481-0158
Phone (201) 251-2525
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3344304 | Medicaid | NJ |
National Provider Directory
National Provider Directory- Tax ID family
- Lisa Cannon MD FCCP
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Medical Specialty Clinic/Center
- Ho Ho Kus, NJ
- NPI 1497079081
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148342400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1193961600000",
"number": "1558316315",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 158",
"city": "WYCKOFF",
"state": "NJ",
"postal_code": "074810158",
"telephone_number": "201-251-2525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 WARREN AVE",
"city": "HO HO KUS",
"state": "NJ",
"postal_code": "074231566",
"telephone_number": "201-251-2525"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LISA CANNON MD FCCP",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-23",
"last_updated": "2007-11-02",
"status": "A",
"authorized_official_last_name": "CANNON",
"authorized_official_first_name": "LISA",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "201-251-2525",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist",
"state": "NJ",
"license": "MA69017",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3344304",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ho Ho Kus, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 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.