Provider Demographics
NPI:1619191145
Name:CALLAHAN, MARIAN V (L AC)
Entity Type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:V
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1621
Mailing Address - Country:US
Mailing Address - Phone:631-979-3855
Mailing Address - Fax:631-265-4083
Practice Address - Street 1:777 MEADOW RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1621
Practice Address - Country:US
Practice Address - Phone:631-979-3855
Practice Address - Fax:631-265-4083
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002182-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist