Provider Demographics
NPI:1467632018
Name:MASCHERINO, EILEEN
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:MASCHERINO
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 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:803-812-3656
Mailing Address - Fax:
Practice Address - Street 1:4709 KIRKWOOD HWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5007
Practice Address - Country:US
Practice Address - Phone:302-998-9880
Practice Address - Fax:302-998-7498
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPTO18884225100000X
DEJ1-0001284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2123130OtherHIGHMARK PABS
DE1467632018OtherDPCI
DEP00692892OtherMEDICARE RAILROAD
PA102372948-0001Medicaid
DE14676320178Medicaid
DE3743700000OtherIBC
PA102372948-0001Medicaid