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General NPI Number Information
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NPI Number | 1881129633
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Entity Type | Individual
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Provider Name | MARIA PEZZOLLA
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Gender | Female
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Dates
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Enumeration Date | 04/28/2017
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Last Update Date | 04/28/2017
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Provider Practice Location Address
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Address Line | 1400 DEER PARK AVE STE 2
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City | NORTH BABYLON
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State | NY
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Zip | 11703-1618
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Country | US
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Telephone | 631-669-6666
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Fax |
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Provider Business Mailing Address
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Address Line | 1991 NANTUCKET RD
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City | MERRICK
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State | NY
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Zip | 11566-1610
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Country | US
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Telephone | 516-644-7668
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F340857-1
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License Number State | NY
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