Provider Demographics
NPI:1083817241
Name:STIUSO, MARY JOAN (APN)
Entity type:Individual
Prefix:MS
First Name:MARY JOAN
Middle Name:
Last Name:STIUSO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2220
Mailing Address - Country:US
Mailing Address - Phone:201-327-0234
Mailing Address - Fax:201-767-3463
Practice Address - Street 1:174 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3585
Practice Address - Country:US
Practice Address - Phone:201-788-1000
Practice Address - Fax:201-767-3463
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNC08530100364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent