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NPI Code Detail

MEDICARE: LISA MARIE DEGOROSTIZA A.P.N

MEDICARE: LISA MARIE DEGOROSTIZA A.P.N
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
1363LA2200XAdult Health Nurse Practitioner26NJ00547600NJ
2363LG0600XGerontology Nurse Practitioner26NJ00547600NJ

General Provider Information

NPI Number : 1487048476
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA MARIE DEGOROSTIZA A.P.N
Provider Business Mailing Address
First Line : 124 GRAND ST
Second Line :
City : HOBOKEN
State : NJ
Zip : 07030-2510
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 124 GRAND ST
Second Line :
City : HOBOKEN
State : NJ
Zip : 07030-2510
Country : US
Telephone Number : 201-963-0300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2015
Last Update Date : 09/22/2016

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