Individual
JENNIN MARY NANGLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15 BORMAN CT, LAKE RONKONKOMA, NY 11779-1982
(631) 484-2020
Mailing address
15 BORMAN CT, LAKE RONKONKOMA, NY 11779-1982
(631) 484-2020
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
—
—
Other
Enumeration date
07/02/2015
Last updated
07/30/2015
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