Healthcare Provider Details

I. General information

NPI: 1700340734
Provider Name (Legal Business Name): NANCY L PANDISCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 N FARVIEW AVE
PARAMUS NJ
07652-2701
US

IV. Provider business mailing address

122 MORNINGSIDE RD
VERONA NJ
07044-1002
US

V. Phone/Fax

Practice location:
  • Phone: 551-579-4441
  • Fax:
Mailing address:
  • Phone: 973-420-6764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL06147200
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: