Provider Demographics
NPI:1104176320
Name:MAESTRI, MARY JO (MS)
Entity type:Individual
Prefix:MS
First Name:MARY JO
Middle Name:
Last Name:MAESTRI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 PRESIDENTIAL PLAZA UHCC- PERINATAL CETER
Mailing Address - Street 2:UNIVERSITY HOSPITAL/UPSTATE MEDICAL CENTER
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202
Mailing Address - Country:US
Mailing Address - Phone:315-464-4458
Mailing Address - Fax:315-464-6388
Practice Address - Street 1:90 PRESIDENTIAL PLAZA UHCC- PERINATAL CETER
Practice Address - Street 2:UNIVERSITY HOSPITAL/UPSTATE MEDICAL CENTER
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202
Practice Address - Country:US
Practice Address - Phone:315-464-4458
Practice Address - Fax:315-464-6388
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS