Provider Demographics
NPI:1750750451
Name:CALISI, JUSTINE CAPPRI
Entity type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:CAPPRI
Last Name:CALISI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:CAPPRI
Other - Last Name:POMPONIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-2315
Mailing Address - Country:US
Mailing Address - Phone:631-559-5115
Mailing Address - Fax:
Practice Address - Street 1:24 NORWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:BLUE POINT
Practice Address - State:NY
Practice Address - Zip Code:11715
Practice Address - Country:US
Practice Address - Phone:631-559-5115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY451964869252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency