Provider Demographics
NPI:1871752626
Name:DESIATO, LISA ANN (PA)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:DESIATO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:DISIATO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:42D CHICOPEE DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1727
Mailing Address - Country:US
Mailing Address - Phone:609-924-1161
Mailing Address - Fax:
Practice Address - Street 1:100 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558-2601
Practice Address - Country:US
Practice Address - Phone:609-279-4860
Practice Address - Fax:609-279-4850
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00071000363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical