Provider Demographics
NPI:1093158537
Name:MAGGIO, MICHELLE FRANCES (LAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:FRANCES
Last Name:MAGGIO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 MERRICK RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4642
Mailing Address - Country:US
Mailing Address - Phone:516-623-3940
Mailing Address - Fax:516-623-3979
Practice Address - Street 1:1955 MERRICK RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4642
Practice Address - Country:US
Practice Address - Phone:516-623-3940
Practice Address - Fax:516-623-3979
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001759171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist