Individual
VANESSA DISLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
30 PROSPECT AVE, HACKENSACK, NJ 07601-1915
(551) 996-4778
Mailing address
30 PROSPECT AVE, HACKENSACK, NJ 07601-1915
(551) 996-4778
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
25MP00184500
NJ
363AS0400X
Surgical Physician Assistant
PA9105002
FL
Other
Enumeration date
06/11/2007
Last updated
03/25/2020
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