Individual
MS. LISA AYMONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
150 DARK HOLLOW RD, PORT JEFFERSON, NY 11777-2048
(631) 473-5400
Mailing address
150 DARK HOLLOW ROAD, PORT JEFFERSON, NY 11777
(631) 473-5400
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
302539
NY
Other
Enumeration date
05/07/2010
Last updated
05/07/2010
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