Healthcare Provider Details

I. General information

NPI: 1265023667
Provider Name (Legal Business Name): JESSICA PISCIONE RN, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 MCDONALD AVE
BROOKLYN NY
11223-4740
US

IV. Provider business mailing address

116 MONTGOMERY BLVD
ATLANTIC BEACH NY
11509-1414
US

V. Phone/Fax

Practice location:
  • Phone: 516-418-6333
  • Fax:
Mailing address:
  • Phone: 516-418-6333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number679236
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number323470
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: