Provider Demographics
NPI:1972864031
Name:INTERMESOLI, JEANNE P (MS)
Entity Type:Individual
Prefix:MISS
First Name:JEANNE
Middle Name:P
Last Name:INTERMESOLI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1422
Mailing Address - Country:US
Mailing Address - Phone:631-786-7129
Mailing Address - Fax:
Practice Address - Street 1:604 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-1422
Practice Address - Country:US
Practice Address - Phone:631-786-0495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist