Provider Demographics
NPI:1417598780
Name:BISSAINTHE, LIONEL
Entity Type:Individual
Prefix:
First Name:LIONEL
Middle Name:
Last Name:BISSAINTHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 RIVER VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:NJ
Mailing Address - Zip Code:07827-3110
Mailing Address - Country:US
Mailing Address - Phone:754-244-2180
Mailing Address - Fax:
Practice Address - Street 1:95 RIVER VIEW WAY
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:NJ
Practice Address - Zip Code:07827-3110
Practice Address - Country:US
Practice Address - Phone:754-244-2180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty