Provider Demographics
NPI:1679883813
Name:PIETROFESA, LIANA J (PA)
Entity Type:Individual
Prefix:
First Name:LIANA
Middle Name:J
Last Name:PIETROFESA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4143 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-5637
Mailing Address - Country:US
Mailing Address - Phone:718-966-5556
Mailing Address - Fax:718-966-7483
Practice Address - Street 1:4143 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5637
Practice Address - Country:US
Practice Address - Phone:718-966-5556
Practice Address - Fax:718-966-7483
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY009039363AM0700X
NJ25MP00113500363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical