Individual
JESSICA SARA MILLER MANTELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
101 NICOLLS RD, STONY BROOK, NY 11794-0001
(631) 444-5437
Mailing address
101 NICOLLS RD, STONY BROOK, NY 11794-0001
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
293180
NY
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
293180
NY
Other
Enumeration date
04/30/2015
Last updated
11/03/2021
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