Individual ProviderMary IannottaLicensed Practical NurseNursing Service ProvidersPractice Address525 S Ocean Ave, Patchogue, NY 11772-3727(631) 786-8273PECOS EnrollmentBased on the most recent information from CMS, provider Mary Iannotta does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1629616065Provider TypeIndividualFull NameIannotta, MaryCredentialLPNGenderFemaleSole ProprietorYesEnumeration Date12/17/2019Last Updated12/17/2019Contact InformationPractice LocationPractice Address525 S Ocean Ave, Patchogue, NY 11772-3727Phone(631) 786-8273FaxUnlisted FaxMailing LocationMailing Address525 S Ocean Ave, Patchogue, NY 11772-3727Phone(631) 786-8273FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode164W00000XPrimaryDescriptionLicensed Practical NurseNursing Service ProvidersLicense337251New York