Provider Demographics
NPI:1609377613
Name:PISKULOSKA, JORDA (NP)
Entity Type:Individual
Prefix:
First Name:JORDA
Middle Name:
Last Name:PISKULOSKA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 ROSSETT ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3918
Mailing Address - Country:US
Mailing Address - Phone:973-713-8199
Mailing Address - Fax:
Practice Address - Street 1:113 E 39TH ST # 115
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0968
Practice Address - Country:US
Practice Address - Phone:212-223-0716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-25
Last Update Date:2018-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3081171363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9666558OtherNURSE PRACTITIONER CERTIFICATE NUMBER