Individual provider Active NPI

Lisa Endanattu, FNP-BC

  • Family Nurse Practitioner
  • Nutley, NJ
National Provider Identifier
1639894793
Registry record updated Oct 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
350529 Issued in NY
Practice address
88 Park Ave Ste 2a
Nutley, NJ 07110-3500
Phone
(973) 571-2121
NPI assigned
Oct 11, 2022
Last updated
Oct 11, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 350529 NY Primary

Addresses

Primary practice location

88 Park Ave Ste 2a
Nutley, NJ 07110-3500

Mailing address

9 E Palisades Ave
Nanuet, NY 10954-3345
Phone (845) 709-1490

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230210000616 NJ Practitioner - Nurse Practitioner 2466824909 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Schweiger Dermatology PCGroup PAC ID 0143442806, 180 clinicians

Practice addresses (Care Compare)

88 Park Ave
Suite 2a
Nutley, NJ 07110-3500
Phone (973) 571-2121

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
350529NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Schweiger Dermatology, PC CurrentSince Oct 1, 2022 Accepting new patients
The Dermatology Group CurrentSince Feb 1, 2021 Accepting new patients

Locations

2 Hudson Pl
Ste 101
Hoboken, NJ 07030
Phone (201) 731-4240

315 E Northfield Rd
Ste 2A
Livingston, NJ 07039
Phone (973) 535-3200

712 E Bay Ave
Ste 18
Manahawkin, NJ 08050

88 Park Ave
Ste 2A
Nutley, NJ 07110
Phone (973) 434-1402

44 State Rt 23
Ste 213
Riverdale, NJ 07457

95 Woodstown Rd
Ste B
Swedesboro, NJ 08085
Phone (856) 358-1500

2701 Queens Plz N
Fl 10
Long Island City, NY 11101
Phone (203) 996-6379

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665446400000",
    "number": "1639894793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 E PALISADES AVE",
            "city": "NANUET",
            "state": "NY",
            "postal_code": "109543345",
            "telephone_number": "845-709-1490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 PARK AVE STE 2A",
            "city": "NUTLEY",
            "state": "NJ",
            "postal_code": "071103500",
            "telephone_number": "973-571-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENDANATTU",
        "first_name": "LISA",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-11",
        "last_updated": "2022-10-11",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "350529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nutley, NJ

Sources for this page

Verify at the official NPI Registry.