Provider Demographics
NPI:1932487618
Name:MAGGIO-SOUDRY, MARIE ANN
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ANN
Last Name:MAGGIO-SOUDRY
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 1:6 SOMERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4609
Mailing Address - Country:US
Mailing Address - Phone:201-658-6130
Mailing Address - Fax:
Practice Address - Street 1:205 ROBIN RD
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1449
Practice Address - Country:US
Practice Address - Phone:201-225-1511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist