Provider Demographics
NPI:1942542204
Name:PENNISI, LEE MARI
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:MARI
Last Name:PENNISI
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 1:6 IVY COVERED WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-2729
Mailing Address - Country:US
Mailing Address - Phone:631-509-4835
Mailing Address - Fax:631-509-4831
Practice Address - Street 1:6 IVY COVERED WAY
Practice Address - Street 2:
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766
Practice Address - Country:US
Practice Address - Phone:631-509-4835
Practice Address - Fax:631-509-4831
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator