Provider Demographics
NPI:1265023667
Name:PISCIONE, JESSICA (RN, CLC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PISCIONE
Suffix:
Gender:F
Credentials:RN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MONTGOMERY BLVD
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11509-1414
Mailing Address - Country:US
Mailing Address - Phone:516-418-6333
Mailing Address - Fax:
Practice Address - Street 1:2390 MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4740
Practice Address - Country:US
Practice Address - Phone:516-418-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY679236163W00000X
NY323470163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse