Individual provider · Type 1 NPI

Kelly Teresa Marvullo

Specialist · Lake Ronkonkoma, NY

NPI number 1699022830 Active

Practice location

43 Dorchester Road
Lake Ronkonkoma, NY 11779-1616

Call (631) 278-2556 Map

Mailing address

43 Dorchester Rd
Lake Ronkonkoma, NY 11779-1616

Specialties and licenses

TaxonomyCodeLicense
Specialist Primary 174400000X1135283 (NY)

Specialist: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

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About NPI 1699022830

Kelly Teresa Marvullo's National Provider Identifier is 1699022830, issued on Aug 7, 2012. The primary taxonomy on file is Specialist (174400000X), and the practice location is in Lake Ronkonkoma, NY. The record was last updated on Aug 7, 2012.