Provider Demographics
NPI:1972051779
Name:MEZZASALMA, JENNIFER LIMOR
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LIMOR
Last Name:MEZZASALMA
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 1:26 WOOD SORRELL LN
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4738
Mailing Address - Country:US
Mailing Address - Phone:646-732-7823
Mailing Address - Fax:
Practice Address - Street 1:26 WOOD SORRELL LN
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-4738
Practice Address - Country:US
Practice Address - Phone:646-732-7823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist