Healthcare Provider Details

I. General information

NPI: 1497020218
Provider Name (Legal Business Name): MARIGRACE ANNE LOMONACO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 10/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CARNEGIE DR
SMITHTOWN NY
11787-2029
US

IV. Provider business mailing address

30 CARNEGIE DR
SMITHTOWN NY
11787-2029
US

V. Phone/Fax

Practice location:
  • Phone: 631-275-0360
  • Fax:
Mailing address:
  • Phone: 631-275-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number392488-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: