Provider Demographics
NPI:1144492729
Name:MASSONI, JILL (NP)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:MASSONI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 BARTER LN
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3904
Mailing Address - Country:US
Mailing Address - Phone:516-579-5502
Mailing Address - Fax:516-579-9077
Practice Address - Street 1:43 BARTER LN
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3904
Practice Address - Country:US
Practice Address - Phone:516-579-5502
Practice Address - Fax:516-579-9077
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302112363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health