| Doctor Name: | MS. LISA AYMONG |
| NPI Number: | 1023336567 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 302539 |
| Business Practice Address: | 150 Dark Hollow Rd Port Jefferson, NY - 117772048 |
| Business Phone Number: | 6314735400 |
| Business Fax Number: | |
| Mailing Address: | 150 Dark Hollow Road, PORT JEFFERSON |
| State: | NY |
| Postal Code: | 11777 |
| Phone Number: | 6314735400 |
| Fax Number: | |
| NPI Enumeration Date: | 05/07/2010 |
| NPI Last Update Date: | 05/07/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0400X |
| License Number: | 302539 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |