Individual
DEBRA CIVITANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
500 MONTAUK HWY, WEST ISLIP, NY 11795-4418
(631) 314-4456
Mailing address
500 MONTAUK HWY STE Q, WEST ISLIP, NY 11795-4420
(631) 314-4456
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F351904-01
NY
Other
Enumeration date
06/12/2023
Last updated
06/12/2023
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