Provider Demographics
NPI:1023027810
Name:MACONY, PC
Entity Type:Organization
Organization Name:MACONY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:W
Authorized Official - Last Name:VIEBROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-528-4047
Mailing Address - Street 1:100 MAPLE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1965
Mailing Address - Country:US
Mailing Address - Phone:413-528-4047
Mailing Address - Fax:413-528-3407
Practice Address - Street 1:100 MAPLE AVE STE 1
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1965
Practice Address - Country:US
Practice Address - Phone:413-528-4047
Practice Address - Fax:413-528-3407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9778754Medicaid
NY01682324Medicaid
MAM20277Medicare ID - Type Unspecified