Provider Demographics
NPI:1104371434
Name:PISCADLO, ANDREA E (APN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:E
Last Name:PISCADLO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:E
Other - Last Name:MCCARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:78 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-2402
Mailing Address - Country:US
Mailing Address - Phone:609-405-2434
Mailing Address - Fax:
Practice Address - Street 1:132 FRANKLIN CORNER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2523
Practice Address - Country:US
Practice Address - Phone:609-896-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00660700363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics