Provider Demographics
NPI:1851124739
Name:DI MAGGIO, JUSTINA PENNISI
Entity type:Individual
Prefix:
First Name:JUSTINA
Middle Name:PENNISI
Last Name:DI MAGGIO
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 1:19 MERRITT AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-7932
Mailing Address - Country:US
Mailing Address - Phone:516-993-6197
Mailing Address - Fax:
Practice Address - Street 1:19 MERRITT AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-7932
Practice Address - Country:US
Practice Address - Phone:516-993-6197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY948499-01163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health