Provider Demographics
NPI:1184906968
Name:SALANDRA-BIRNBAUM, LISA (NP-C, APN-C)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:SALANDRA-BIRNBAUM
Suffix:
Gender:F
Credentials:NP-C, APN-C
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:SALANDRA-BIRNBAUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C, APN-C
Mailing Address - Street 1:99 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677
Mailing Address - Country:US
Mailing Address - Phone:201-925-0123
Mailing Address - Fax:201-307-1016
Practice Address - Street 1:350 ENGLE ST
Practice Address - Street 2:EHMC
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:877-273-2782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00328800363L00000X
NYF305661-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner