Provider Demographics
NPI:1043049778
Name:BISAREK, ANNA M (RBT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:BISAREK
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:M
Other - Last Name:BISAREK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:311 BOULEVARD OF THE AMERICAS
Mailing Address - Street 2:STE 304
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:732-806-0091
Mailing Address - Fax:
Practice Address - Street 1:3604 TWIN CREEK DR STE 107
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-4079
Practice Address - Country:US
Practice Address - Phone:402-990-5460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician