Individual
JILL SISSELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
627 BROADWAY, SUITE 1, MASSAPEQUA, NY 11758-5031
(516) 308-4040
(516) 804-6386
Mailing address
627 BROADWAY, SUITE 1, MASSAPEQUA, NY 11758-5031
(516) 308-4040
(516) 804-6386
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
216154
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02236368
—
NY
Enumeration date
12/11/2006
Last updated
10/12/2022
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