Provider Demographics
NPI:1376283861
Name:MACASIEB, JOSEPHINE RUSIANA
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:RUSIANA
Last Name:MACASIEB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-7323
Mailing Address - Country:US
Mailing Address - Phone:201-851-8104
Mailing Address - Fax:
Practice Address - Street 1:238 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-7323
Practice Address - Country:US
Practice Address - Phone:201-851-8104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0332000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health