Provider Demographics
NPI:1265206510
Name:MAAGAD, LANIE ALVAREZ
Entity type:Individual
Prefix:
First Name:LANIE
Middle Name:ALVAREZ
Last Name:MAAGAD
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 1:77 MAPLE AVE APT C10
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3534
Mailing Address - Country:US
Mailing Address - Phone:631-871-3461
Mailing Address - Fax:
Practice Address - Street 1:77 MAPLE AVE APT C10
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3534
Practice Address - Country:US
Practice Address - Phone:631-871-3461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY662130163WN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0300XNursing Service ProvidersRegistered NurseNephrology