Healthcare Provider Details

I. General information

NPI: 1669349270
Provider Name (Legal Business Name): LISA CANGIALOSI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 VALLEY RD #1345
CLIFTON NJ
07013-1319
US

IV. Provider business mailing address

377 VALLEY RD # 1345
CLIFTON NJ
07013-1319
US

V. Phone/Fax

Practice location:
  • Phone: 201-446-3866
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15431800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: