Individual
JAKE ZOSIMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
299 HALLOCK AVE, PORT JEFFERSON STATION, NY 11776-1217
(631) 473-4284
Mailing address
2 YARMOUTH LN, CENTER MORICHES, NY 11934-2009
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/02/2024
Last updated
01/02/2024
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