Provider Demographics
NPI:1114042231
Name:LISOWSKI, ANDREA (ANDREA LISOWSKI DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:LISOWSKI
Suffix:
Gender:F
Credentials:ANDREA LISOWSKI DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-2314
Mailing Address - Country:US
Mailing Address - Phone:973-473-2410
Mailing Address - Fax:973-473-4552
Practice Address - Street 1:1149 BLOOMFIELD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-2314
Practice Address - Country:US
Practice Address - Phone:973-473-2410
Practice Address - Fax:973-473-4552
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ16500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist