Vanessa Disla, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

25MP00184500 Issued in NJ

Practice address

30 Prospect Ave
Hackensack, NJ 07601-1915

Phone

(551) 996-4778

NPI assigned

Jun 11, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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

• TC Plastic Surgery Corp

  • Plastic and Reconstructive Surgery Physician
  • Englewood, NJ
  • NPI 1013707769
  NPD (past)

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585094400000",
    "number": "1801090253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 PROSPECT AVE",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076011915",
            "telephone_number": "551-996-4778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 PROSPECT AVE",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076011915",
            "telephone_number": "551-996-4778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISLA",
        "first_name": "VANESSA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-11",
        "last_updated": "2020-03-25",
        "certification_date": "2020-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9105002",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NJ",
            "license": "25MP00184500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "vanessa.disla@hackensack.meridian.org",
            "affiliation": "N",
            "address_1": "30 Prospect Ave",
            "city": "Hackensack",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "076011915",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Calogero F Dimaggio, D.D.S
• Anthony J Diomede, R.PH.
• Lauren Elyse Dipasquale, AU.D.
• Frank Joseph Diroma, D.O.
• Thomas Mariano Disanto, MD
• Jared Ditkowsky, MD
• Alexandra Ditroia, MA
• Shaili N Dixit, MD, DPT
• Michael Stephen Doblin, D.D.S.
• Dobson Chiropractic Health Center PC

• Surgical Physician Assistant in Hackensack, NJ
• Providers in Hackensack, NJ by specialty
• Surgical Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.