Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jennifer Grace Wiley

Individual provider Specialist · NPI 1821351602

Jennifer Grace Wiley is a Specialist in Lake Ronkonkoma, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2012

Practice location Address checks out

10 Center St
Lake Ronkonkoma, NY 11779-4524
Phone: (631) 428-3508
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence 899067 (NY)

Record details

NPI number1821351602
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJune 18, 2012
Last updated in NPPESJune 18, 2012

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