Healthcare Provider Details

I. General information

NPI: 1609925999
Provider Name (Legal Business Name): LISA ANNE MASCALL PT, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CLINTON PL
HACKENSACK NJ
07601-4579
US

IV. Provider business mailing address

50 CLINTON PL
HACKENSACK NJ
07601-4579
US

V. Phone/Fax

Practice location:
  • Phone: 201-561-1240
  • Fax:
Mailing address:
  • Phone: 201-561-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number005836
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number027805-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01027200
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00130000
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: