Jacqueline Sommer Colalillo
Physician Assistant in Lake Grove, NY. Individual provider (NPI-1).
NPI number1104701671
StatusActive
Last updated in NPPESAug 25, 2025
Details
- NPI
- 1104701671
- Entity type
- Individual (NPI-1)
- Name
- Jacqueline Sommer Colalillo
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Aug 6, 2025
- Certification date
- Aug 25, 2025
- Last updated
- Aug 25, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | – | – | Yes |
Practice location
4 Smith Haven Mall Ste 110Lake Grove, NY 11755-1219
Phone 631-444-6270
Mailing address
4 Smith Haven Mall Ste 110Lake Grove, NY 11755-1219
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