Healthcare Provider Details

I. General information

NPI: 1942143318
Provider Name (Legal Business Name): JOANNA PATRICE LENNON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNA CASTROGIVANNI

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 COUNTY RD 97
STONY BROOK NY
11794-0001
US

IV. Provider business mailing address

8130 DEVON ST
PHILADELPHIA PA
19118-3418
US

V. Phone/Fax

Practice location:
  • Phone: 631-689-8333
  • Fax:
Mailing address:
  • Phone: 631-617-2069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF383922-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: