Provider Demographics
NPI:1457536351
Name:MARESCA-TROIANO, JO ANN COLLETTE (RPH)
Entity Type:Individual
Prefix:MS
First Name:JO ANN
Middle Name:COLLETTE
Last Name:MARESCA-TROIANO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LAKES RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-2616
Mailing Address - Country:US
Mailing Address - Phone:845-783-1330
Mailing Address - Fax:845-781-4341
Practice Address - Street 1:2 LAKES RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-2616
Practice Address - Country:US
Practice Address - Phone:845-783-1330
Practice Address - Fax:845-781-4341
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01448122Medicaid