MS. Kelly Teresa Marvullo

NPI #1699022830 in Lake Ronkonkoma, New York

Provider Information

NPI Number: 1699022830
Entity Type: Individual
Name: MS. Kelly Teresa Marvullo
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Specialist
Enumeration Date: Aug 7, 2012
Last Updated: Aug 7, 2012

Practice Location

Address: 43 DORCHESTER ROAD
City: Lake Ronkonkoma
State: New York
ZIP Code: 11779-1616
Phone: (631) 278-2556

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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