Individual
JENNIFER PANTOLIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 ROUTE 347 BLDG 14A, STONY BROOK, NY 11790-2554
(631) 689-7800
Mailing address
2500 ROUTE 347 BLDG 14A, STONY BROOK, NY 11790-2554
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
308041
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
308041
LICENSE
NY
Enumeration date
11/17/2016
Last updated
11/17/2016
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