Individual
LISA ANTONIA STACCONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
550 1ST AVE, NEW YORK, NY 10016-6402
(212) 263-6600
Mailing address
53 SINTSINK DR E, PORT WASHINGTON, NY 11050-2043
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F305420
NY
Other
Enumeration date
12/07/2010
Last updated
04/02/2021
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