Individual
JACQUELYN ROSE LANCIOTTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
30 PRINCETON ST, GARDEN CITY, NY 11530-4006
(516) 508-0744
Mailing address
30 PRINCETON ST, GARDEN CITY, NY 11530-4006
(516) 508-0744
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CJL063W10625
EMPIRE BLUE CROSS BLUE SHIELD
NY
Enumeration date
03/10/2023
Last updated
03/10/2023
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