Provider Demographics
NPI:1033551825
Name:CORDARO, LISA (PNP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:CORDARO
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:HO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 SQUIRETOWN RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2011
Mailing Address - Country:US
Mailing Address - Phone:631-728-5300
Mailing Address - Fax:631-728-5360
Practice Address - Street 1:5 SQUIRETOWN RD
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2011
Practice Address - Country:US
Practice Address - Phone:631-728-5300
Practice Address - Fax:631-728-5360
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR15982000163W00000X
NY307465-1163W00000X
NYF382436-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse