Provider Demographics
NPI:1457385635
Name:PISINSKA, MARTA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:
Last Name:PISINSKA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 SLOCUM WAY
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5306
Mailing Address - Country:US
Mailing Address - Phone:917-842-0366
Mailing Address - Fax:
Practice Address - Street 1:160 LANZA AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-3510
Practice Address - Country:US
Practice Address - Phone:973-955-2023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050321-11223G0001X
NJ22DI022593001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02388250Medicaid