Provider Demographics
NPI:1881934792
Name:PISANO, ROBERT (LFD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:PISANO
Suffix:
Gender:M
Credentials:LFD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6847 EXETER ST.
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:347-528-6350
Mailing Address - Fax:
Practice Address - Street 1:773 9TH AVE.
Practice Address - Street 2:
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-586-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6654619164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse