Provider Demographics
NPI:1285177725
Name:RAGONA, JENNIFER (MSED)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RAGONA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MELKUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:80 BLACKHEATH RD
Mailing Address - Street 2:
Mailing Address - City:LIDO BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4842
Mailing Address - Country:US
Mailing Address - Phone:516-526-5665
Mailing Address - Fax:
Practice Address - Street 1:264 BEACH 19TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4431
Practice Address - Country:US
Practice Address - Phone:718-868-2961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency