Provider Demographics
NPI:1295984250
Name:MCKENNA, MARIA PAOLA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:PAOLA
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:PAOLA
Other - Last Name:PRINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:22 SAW MILL RIVER ROAD,
Mailing Address - Street 2:2ND. FLOOR
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-7507
Mailing Address - Country:US
Mailing Address - Phone:914-594-3916
Mailing Address - Fax:914-594-3585
Practice Address - Street 1:19 BRADHURST AVE.,
Practice Address - Street 2:SUITE # 2400
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532
Practice Address - Country:US
Practice Address - Phone:914-594-3916
Practice Address - Fax:914-594-3585
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253906208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03027910Medicaid
NYA400023347Medicare PIN
NY03027910Medicaid