Healthcare Provider Details

I. General information

NPI: 1821312042
Provider Name (Legal Business Name): LISA LUSARDI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date: 06/11/2024
Reactivation Date: 06/21/2024

III. Provider practice location address

37 WALL ST APT 21P
NEW YORK NY
10005-2024
US

IV. Provider business mailing address

37 WALL ST APT 21P
NEW YORK NY
10005-2024
US

V. Phone/Fax

Practice location:
  • Phone: 954-551-7295
  • Fax:
Mailing address:
  • Phone: 954-551-7295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number559868
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number559868
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: