Individual
JESSICA FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5225 NESCONSET HIGHWAY, SUITE 30, PORT JEFFERSON STATION, NY 11776-2060
(631) 473-4284
Mailing address
132 MILLIGAN ROAD, WEST BABYLON, NY 11704-8236
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
NY
Other
Enumeration date
04/14/2009
Last updated
04/14/2009
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