MEDICARE: EMILY LISA MONDERINE APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ15475400	NJ

General Provider Information

NPI Number	:	1356206569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY LISA MONDERINE APRN

Provider Business Mailing Address
First Line	:	36 WASHINGTON ST STE 1
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-7667
Country	:	US
Telephone Number	:	201-942-5099
Fax Number	:	877-485-8918

Provider Business Practice Location Address
First Line	:	36 WASHINGTON ST STE 1
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-7667
Country	:	US
Telephone Number	:	201-942-5099
Fax Number	:	877-485-8918

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	06/05/2026

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