Individual
MS. LISA MARGARET MENNELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
TVI
Contact information
Practice address
785 W END AVE, 5E, NEW YORK, NY 10025-5466
(917) 658-1555
Mailing address
785 W END AVE, 5E, NEW YORK, NY 10025-5466
(917) 658-1555
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
NY
Other
Enumeration date
09/02/2010
Last updated
09/02/2010
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