Provider Demographics
NPI:1629231774
Name:MACEDON, PARRIS MARIE
Entity Type:Individual
Prefix:MS
First Name:PARRIS
Middle Name:MARIE
Last Name:MACEDON
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 1:1075 E 179TH ST
Mailing Address - Street 2:#4H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-2325
Mailing Address - Country:US
Mailing Address - Phone:718-542-1357
Mailing Address - Fax:
Practice Address - Street 1:1075 E 179TH ST
Practice Address - Street 2:#4H
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-2325
Practice Address - Country:US
Practice Address - Phone:718-542-1357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services