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General NPI Number Information
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NPI Number | 1871752626
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Entity Type | Individual
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Provider Name | LISA ANN DESIATO PA
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Gender | Female
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 100 BUSINESS PARK DR
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City | SKILLMAN
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State | NJ
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Zip | 08558-2601
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Country | US
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Telephone | 609-279-4860
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Fax | 609-279-4850
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Provider Business Mailing Address
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Address Line | 42D CHICOPEE DR
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City | PRINCETON
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State | NJ
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Zip | 08540-1727
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Country | US
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Telephone | 609-924-1161
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00071000
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License Number State | NJ
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