Provider Demographics
NPI:1356847362
Name:CERNILLI, LAUREEN
Entity Type:Individual
Prefix:
First Name:LAUREEN
Middle Name:
Last Name:CERNILLI
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 1:4 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-3219
Mailing Address - Country:US
Mailing Address - Phone:516-456-3703
Mailing Address - Fax:
Practice Address - Street 1:42 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3813
Practice Address - Country:US
Practice Address - Phone:516-456-3703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY680115-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health