Provider Demographics
NPI:1528767852
Name:INZERO, JUSTINE M
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:M
Last Name:INZERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SOUTH DR RM 120A ROCKLAND HALL
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8700
Mailing Address - Country:US
Mailing Address - Phone:631-632-8984
Mailing Address - Fax:
Practice Address - Street 1:101 SOUTH DR RM 120A ROCKLAND HALL
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8700
Practice Address - Country:US
Practice Address - Phone:631-632-8984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program