Healthcare Provider Details

I. General information

NPI: 1356206569
Provider Name (Legal Business Name): EMILY LISA MONDERINE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 WASHINGTON ST STE 1
TOMS RIVER NJ
08753-7667
US

IV. Provider business mailing address

36 WASHINGTON ST STE 1
TOMS RIVER NJ
08753-7667
US

V. Phone/Fax

Practice location:
  • Phone: 201-942-5099
  • Fax: 877-485-8918
Mailing address:
  • Phone: 201-942-5099
  • Fax: 877-485-8918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15475400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: