Provider Demographics
NPI:1750110268
Name:LISCIO, ANDREW (RN)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:LISCIO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4040
Mailing Address - Country:US
Mailing Address - Phone:310-614-5584
Mailing Address - Fax:
Practice Address - Street 1:151 MARKHAM PL
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1400
Practice Address - Country:US
Practice Address - Phone:732-838-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR26163600163WA2000X, 163WC1600X, 163WI0500X, 163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant