Individual
MRS. DENISE NILSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
396 HARRISON AVE, MASSAPEQUA, NY 11758-6409
(516) 428-9656
Mailing address
396 HARRISON AVE, MASSAPEQUA, NY 11758-6409
(516) 428-9656
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
871483
NY
Other
Enumeration date
09/20/2016
Last updated
09/20/2016
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