Provider Demographics
NPI:1346431236
Name:MACAGNONE, STEVEN VINCENT (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:VINCENT
Last Name:MACAGNONE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 N BROADWAY
Mailing Address - Street 2:SUITE LE2
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2025
Mailing Address - Country:US
Mailing Address - Phone:516-433-4242
Mailing Address - Fax:516-433-4393
Practice Address - Street 1:366 N BROADWAY
Practice Address - Street 2:SUITE LE2
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2025
Practice Address - Country:US
Practice Address - Phone:516-433-4242
Practice Address - Fax:516-433-4393
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006280-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX51501Medicare PIN