Individual
JOSEPH L LISELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
144 GRAND ST, JERSEY CITY, NJ 07302-4431
(973) 907-6428
Mailing address
101 PIER LN, FAIRFIELD, NJ 07004-2110
(973) 907-6428
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
25MT00229000
NJ
Other
Enumeration date
06/21/2017
Last updated
06/21/2017
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