Provider Demographics
NPI:1760428817
Name:SCHISANO, DENIS (MD)
Entity Type:Individual
Prefix:DR
First Name:DENIS
Middle Name:
Last Name:SCHISANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 290
Mailing Address - Street 2:
Mailing Address - City:VAUXHALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07088-0290
Mailing Address - Country:US
Mailing Address - Phone:201-512-9494
Mailing Address - Fax:
Practice Address - Street 1:646 SANFORD AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106-3036
Practice Address - Country:US
Practice Address - Phone:973-373-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA33375207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0624403Medicaid
NJC57095Medicare UPIN