MISS Jennifer Disla

NPI #1003249020 in Corona, New York

Provider Information

NPI Number: 1003249020
Entity Type: Individual
Name: MISS Jennifer Disla
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Specialist
Enumeration Date: Aug 13, 2013
Last Updated: Aug 13, 2013

Practice Location

Address: 11172 42ND AVE
City: Corona
State: New York
ZIP Code: 11368-2620
Phone: (718) 458-0571

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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