Provider Demographics
NPI:1649834698
Name:FALLI, MAURA ROSE
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:ROSE
Last Name:FALLI
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 1:116 TOAD PASTURE RD
Mailing Address - Street 2:
Mailing Address - City:WESTTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10998-2729
Mailing Address - Country:US
Mailing Address - Phone:845-239-9447
Mailing Address - Fax:
Practice Address - Street 1:101 NICOLLS ROAD PHARMACY DEPARTMENT LEVEL #1
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-2860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program