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General NPI Number Information
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NPI Number | 1306249735
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Entity Type | Individual
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Provider Name | JANINE DESIMONE NPP
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Gender | Female
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Dates
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Enumeration Date | 09/30/2014
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 47 ROUTE 25A
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City | SETAUKET
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State | NY
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Zip | 11733-2881
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Country | US
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Telephone | 631-780-4103
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Fax | 631-250-9215
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Provider Business Mailing Address
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Address Line | 7 BRASSWOOD RD
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City | SAINT JAMES
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State | NY
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Zip | 11780-3411
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Country | US
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Telephone | 631-921-1949
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 40 401937
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 475699-1
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License Number State | NY
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