Provider Demographics
NPI:1265642383
Name:MAGLIACANO, KAREN LYNN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:MAGLIACANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:MAGLIACANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AT,C
Mailing Address - Street 1:679 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2523
Mailing Address - Country:US
Mailing Address - Phone:908-464-0829
Mailing Address - Fax:908-464-0829
Practice Address - Street 1:679 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2523
Practice Address - Country:US
Practice Address - Phone:908-464-0829
Practice Address - Fax:908-464-0829
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000972002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer