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General NPI Number Information
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NPI Number | 1487319158
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Entity Type | Individual
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Provider Name | NICHOLAS DESISTO
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Gender | Male
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Dates
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Enumeration Date | 11/07/2021
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Last Update Date | 11/07/2021
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Provider Practice Location Address
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Address Line | 615 HOPE RD STE 3B
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City | EATONTOWN
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State | NJ
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Zip | 07724-1273
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Country | US
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Telephone | 732-724-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 21 ALESSIO TER
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City | HAMILTON
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State | NJ
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Zip | 08620-9772
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Country | US
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Telephone | 609-477-8557
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | NJ
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