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General NPI Number Information
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NPI Number | 1174630263
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Entity Type | Individual
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Provider Name | JENNIFER ANN NASTASI D.O.
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Gender | Female
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 2799 ROUTE 112 STE 11
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City | MEDFORD
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State | NY
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Zip | 11763-2535
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Country | US
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Telephone | 631-732-5222
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Fax | 631-732-6222
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Provider Business Mailing Address
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Address Line | 14 HERMITAGE ST
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City | WADING RIVER
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State | NY
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Zip | 11792-9204
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Country | US
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Telephone | 631-929-8330
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 228056
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License Number State | NY
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