Individual
AGNES PERCOCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
627 JAYNE BLVD, PORT JEFFERSON, NY 11776-2947
(631) 331-5218
Mailing address
627 JAYNE BLVD, PORT JEFFERSON STATION, NY 11776-2947
(631) 331-5218
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
144237-1
NY
Other
Enumeration date
02/03/2015
Last updated
02/03/2015
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