Provider Demographics
NPI:1700166923
Name:PISANO, LEONARD VINCENT (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:VINCENT
Last Name:PISANO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 TITUS LN
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-1118
Mailing Address - Country:US
Mailing Address - Phone:609-799-3941
Mailing Address - Fax:
Practice Address - Street 1:6 TITUS LN
Practice Address - Street 2:
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-1118
Practice Address - Country:US
Practice Address - Phone:609-799-3941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100373700103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist