Basic Information
| Provider Information | |||||||||
| NPI: | 1821606963 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELLISSIMO | ||||||||
| FirstName: | ELISABETH | ||||||||
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| Credential: | MSN, RN, CPNP-PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 347 VARICK ST APT 210A | ||||||||
| Address2: | |||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073028409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085247017 | ||||||||
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| Practice Location | |||||||||
| Address1: | 180 FORT WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123053535 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2020 | ||||||||
| LastUpdateDate: | 07/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 383079 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.