Provider Demographics
NPI:1043554041
Name:DI PESO, JESSICA TUZZOLINO (NP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:TUZZOLINO
Last Name:DI PESO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:TUZZOLINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:REGIONAL ONCOLOGY CENTER
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2342
Mailing Address - Country:US
Mailing Address - Phone:315-464-8200
Mailing Address - Fax:315-464-8206
Practice Address - Street 1:4900 BROAD RD.
Practice Address - Street 2:UPSTATE COMMUNITY MEDICAL
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-2342
Practice Address - Country:US
Practice Address - Phone:315-464-8200
Practice Address - Fax:315-464-8206
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337407363LF0000X
NYF337407-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03519968Medicaid
NYJ400082892Medicare PIN