Provider Demographics
NPI:1457681140
Name:DISIENA, JESSICA LYNN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LYNN
Last Name:DISIENA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 GARTH RD
Mailing Address - Street 2:APT. 5 D
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3753
Mailing Address - Country:US
Mailing Address - Phone:518-879-5467
Mailing Address - Fax:
Practice Address - Street 1:1024 BROADWAY
Practice Address - Street 2:THORNWOOD TOWN CENTER
Practice Address - City:THORNWOOD
Practice Address - State:NY
Practice Address - Zip Code:10594-1133
Practice Address - Country:US
Practice Address - Phone:914-769-0558
Practice Address - Fax:914-773-2036
Is Sole Proprietor?:No
Enumeration Date:2010-01-03
Last Update Date:2010-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053564-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist