Jennifer Disla

NPI 1003249020 - Specialist - 174400000X

NPI Details
NPI 1003249020
Gender Female
Enumeration Date 08/13/2013
Last Updated 08/13/2013
Entity Type Individual
Active Over 3 years ago
Practice Location
11172 42ND AVE
CORONA NY, 11368-2620, US
Phone (718) 458-0571
Fax
Business Location
111-72 42ND AVENUE
CORONA MT, 11368, US
Phone (718) 458-0571
Fax
Toxanomy
Taxonomy Code 174400000X
License State New York
License Number 1191109
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According to our database, Miss Jennifer Disla NPI is 1003249020, taxonomy code is 174400000X and license number is 1191109, license state is located at New York. Jennifer Disla physically located at 11172 42nd Ave, Corona NY, 11368-2620. NPI Number Jennifer Disla has the Individual type.

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1003249020 NPI number is provided on an as is basis without warranty of any kind. 1003249020 is maintained by the National Plan & Provider Enumeration System. The contents of Jennifer Disla are for informational purposes only.