Individual
JENNIFER CASILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
148 BURNEY BLVD, MASTIC, NY 11950-1335
(631) 494-5966
Mailing address
148 BURNEY BLVD, MASTIC, NY 11950-1335
(631) 494-5966
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F309348-01
NY
Other
Enumeration date
08/04/2019
Last updated
08/04/2019
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