Individual
MRS. JESSICA MARIE DONOFRIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1050 OLD NICHOLS RD, ISLANDIA, NY 11749-5026
(631) 828-4545
Mailing address
32 PATRICIA LN, LAKE GROVE, NY 11755-2843
(631) 375-0138
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
018211
NY
Other
Enumeration date
10/24/2014
Last updated
11/15/2021
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