Provider Demographics
NPI:1417140062
Name:AGNELLO, DENISE MARY
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:MARY
Last Name:AGNELLO
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 1:50 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2818
Mailing Address - Country:US
Mailing Address - Phone:631-650-5845
Mailing Address - Fax:
Practice Address - Street 1:50 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2818
Practice Address - Country:US
Practice Address - Phone:631-650-5845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist