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General NPI Number Information
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NPI Number | 1275836256
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Entity Type | Organization
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Legal Business Name | LISA PERRINO INC
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 12/13/2010
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Provider Practice Location Address
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Address Line | 515 CHAPMAN BLVD
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City | MANORVILLE
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State | NY
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Zip | 11949
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Country | US
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Telephone | 631-909-3346
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Fax | 631-909-3346
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Provider Business Mailing Address
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Address Line | 515 CHAPMAN BLVD
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City | MANORVILLE
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State | NY
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Zip | 11949-9591
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Country | US
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Telephone | 631-909-3346
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Fax | 631-909-3346
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | MS. LISA MARIE PERRINO
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Credential |
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Telephone | 631-245-5868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 599476
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License Number State | NY
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