Provider Demographics
NPI:1457960965
Name:PENNACCHI, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:PENNACCHI
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 1:1657 BAY RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5010
Mailing Address - Country:US
Mailing Address - Phone:347-446-5312
Mailing Address - Fax:
Practice Address - Street 1:711 AVENUE U FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4133
Practice Address - Country:US
Practice Address - Phone:347-446-5312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist