Provider Demographics
NPI:1255566931
Name:MAFFUCCI, DAWN MARIE (ATC, LMT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:MAFFUCCI
Suffix:
Gender:F
Credentials:ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3812
Mailing Address - Country:US
Mailing Address - Phone:862-520-2808
Mailing Address - Fax:
Practice Address - Street 1:15 CORPORATE DR
Practice Address - Street 2:UNIT 6
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3120
Practice Address - Country:US
Practice Address - Phone:919-225-4286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-25
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001483002255A2300X
NJ26BT00197500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer