Individual
MRS. JOANNA ROSE DEMATTEO KOPF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
12 CANNON DR, HOLBROOK, NY 11741-5202
(631) 256-6493
(631) 256-6493
Mailing address
12 CANNON DR, HOLBROOK, NY 11741-5202
(631) 256-6493
(631) 256-6493
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
429547-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01261816
—
NY
Enumeration date
05/20/2008
Last updated
05/20/2008
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