Provider Demographics
NPI:1023737855
Name:PIANTANIDA, MARIA LISA (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:LISA
Last Name:PIANTANIDA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1418
Mailing Address - Country:US
Mailing Address - Phone:732-859-4462
Mailing Address - Fax:
Practice Address - Street 1:23 WHITE ST SIDE ENTRANCE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4477
Practice Address - Country:US
Practice Address - Phone:732-444-8802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01358000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMP7457042OtherDEA