Healthcare Provider Details

I. General information

NPI: 1457385635
Provider Name (Legal Business Name): MARTA PISINSKA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 LANZA AVE SUITE 11
GARFIELD NJ
07026-3510
US

IV. Provider business mailing address

274 SLOCUM WAY
FORT LEE NJ
07024-5306
US

V. Phone/Fax

Practice location:
  • Phone: 973-955-2023
  • Fax:
Mailing address:
  • Phone: 917-842-0366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number050321-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02259300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: