Basic Information
| Provider Information | |||||||||
| NPI: | 1144492729 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASSONI | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 BARTER LN | ||||||||
| Address2: | |||||||||
| City: | HICKSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 118013904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165795502 | ||||||||
| FaxNumber: | 5165799077 | ||||||||
| Practice Location | |||||||||
| Address1: | 43 BARTER LN | ||||||||
| Address2: | |||||||||
| City: | HICKSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 118013904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165795502 | ||||||||
| FaxNumber: | 5165799077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2008 | ||||||||
| LastUpdateDate: | 02/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | F302112 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.