| Doctor Name: | LISA M CANNON |
| NPI Number: | 1073562773 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | MA69017 |
| Business Practice Address: | 110 Warren Ave Ho Ho Kus, NJ - 074231566 |
| Business Phone Number: | 2012512525 |
| Business Fax Number: | 2012518488 |
| Mailing Address: | Po Box 158, WYCKOFF |
| State: | NJ |
| Postal Code: | 074810158 |
| Phone Number: | 2015129494 |
| Fax Number: | 2015121995 |
| NPI Enumeration Date: | 05/09/2006 |
| NPI Last Update Date: | 11/20/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | MA69017 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |