Healthcare Provider Details

I. General information

NPI: 1902534621
Provider Name (Legal Business Name): LISA DIPIETROPOLO PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 JFK PARKWAY 1ST FLOOR WEST
SHORT HILLS NJ
07078
US

IV. Provider business mailing address

51 JFK PKWY
SHORT HILLS NJ
07078-2704
US

V. Phone/Fax

Practice location:
  • Phone: 609-332-0881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NR15439400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number26NJ01379900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: