Provider Demographics
NPI:1821475666
Name:BALDISSEROTTO, OLIVIA AYSE (FNP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:AYSE
Last Name:BALDISSEROTTO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:AYSE
Other - Last Name:KURTOGLU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1500 WASHINGTON ST APT 6A
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6736
Mailing Address - Country:US
Mailing Address - Phone:203-526-5560
Mailing Address - Fax:
Practice Address - Street 1:136 MOUNTAINVIEW BLVD
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-3444
Practice Address - Country:US
Practice Address - Phone:908-542-3401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339381363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily