Provider Demographics
NPI:1184892168
Name:DR C J MACRI INC
Entity type:Organization
Organization Name:DR C J MACRI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MACRI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-652-5191
Mailing Address - Street 1:1702 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-1234
Mailing Address - Country:US
Mailing Address - Phone:724-652-5191
Mailing Address - Fax:724-652-8160
Practice Address - Street 1:1702 W STATE ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-1234
Practice Address - Country:US
Practice Address - Phone:724-652-5191
Practice Address - Fax:724-652-8160
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR CANDICE J MACRI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA095201Medicare PIN