Provider Demographics
NPI:1659410272
Name:MECCARIELLO, LYNNE MARY (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:MARY
Last Name:MECCARIELLO
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 RICHBELL RD
Mailing Address - Street 2:APT B4
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3263
Mailing Address - Country:US
Mailing Address - Phone:914-833-7374
Mailing Address - Fax:
Practice Address - Street 1:336 RICHBELL RD
Practice Address - Street 2:APT B4
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3263
Practice Address - Country:US
Practice Address - Phone:914-833-7374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003656363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003656OtherSTATE LICENSE NUMBER