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General NPI Number Information
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NPI Number | 1063509925
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Entity Type | Individual
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Provider Name | JENNIFER MEGAN CEONZO O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 03/05/2019
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Provider Practice Location Address
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Address Line | 150 BROADHOLLOW RD STE 104
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City | MELVILLE
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State | NY
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Zip | 11747-4901
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Country | US
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Telephone | 631-791-5155
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Fax | 631-791-5154
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Provider Business Mailing Address
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Address Line | 5 WINDSOR PL
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City | MELVILLE
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State | NY
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Zip | 11747-1331
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Country | US
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Telephone | 631-673-1950
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV006541
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License Number State | NY
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