Provider Demographics
NPI:1972866416
Name:CHIUSANO, JESSICA LYN
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYN
Last Name:CHIUSANO
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 1:44 OVERTON AVE
Mailing Address - Street 2:44 OVERTON AVE
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2416
Mailing Address - Country:US
Mailing Address - Phone:631-871-4902
Mailing Address - Fax:
Practice Address - Street 1:44 OVERTON AVE
Practice Address - Street 2:44 OVERTON AVE
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2416
Practice Address - Country:US
Practice Address - Phone:631-871-4902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211483032174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist