Individual
JACQUELYN SUE KORNBLATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
145 COMMACK RD, COMMACK, NY 11725-3438
(631) 499-5360
(631) 499-5568
Mailing address
145 COMMACK RD, COMMACK, NY 11725-3438
(631) 499-5360
(631) 499-5568
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
12/30/2008
Last updated
12/30/2008
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