Individual
MS. ALYSSA MARIE DE GENNARO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
103 MADISON ST, MASTIC, NY 11950-3901
(631) 682-9504
Mailing address
103 MADISON ST, MASTIC, NY 11950-3901
(631) 682-9504
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
304428-1
NY
Other
Enumeration date
03/24/2011
Last updated
03/24/2011
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