Provider Demographics
NPI:1083944847
Name:LENNON, ALINE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:ALINE
Middle Name:MARIE
Last Name:LENNON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALINE
Other - Middle Name:MARIE
Other - Last Name:GAMBESKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:4619 LITTLE NECK PKWY
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1428
Mailing Address - Country:US
Mailing Address - Phone:718-428-7400
Mailing Address - Fax:718-428-7405
Practice Address - Street 1:4619 LITTLE NECK PKWY
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-1428
Practice Address - Country:US
Practice Address - Phone:718-428-7400
Practice Address - Fax:718-428-7405
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305240363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health