Provider Demographics
NPI:1003810433
Name:MAGGIO, GARY A (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:MAGGIO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:671 MONTAUK HWY
Mailing Address - Street 2:STE A
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1607
Mailing Address - Country:US
Mailing Address - Phone:631-472-3535
Mailing Address - Fax:631-472-8221
Practice Address - Street 1:671 MONTAUK HWY
Practice Address - Street 2:STE A
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1607
Practice Address - Country:US
Practice Address - Phone:631-472-3535
Practice Address - Fax:631-472-8221
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-002296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY112504440OtherEMPIRE
NYX8X13OtherEMPIRE BLUE CROSS
NY10191OtherVYTRA
NY1518OtherACCESS
NY457024OtherUS HEALTHCARE
NY8570800OtherCIGNA
NYP463321OtherOXFORD
NYX13181Medicare PIN