Individual
MRS. JANE ANN WYLIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
600 S SERVICE RD, DIX HILLS, NY 11746-6015
(631) 271-0777
Mailing address
5 GARDEN AVE, LAKE RONKONKOMA, NY 11779-1711
(631) 806-3091
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
5662941111
NY
Other
Enumeration date
05/12/2018
Last updated
05/12/2018
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