Provider Demographics
NPI:1669701165
Name:LISA A. MAFFUCCI, D.C., PLLC
Entity type:Organization
Organization Name:LISA A. MAFFUCCI, D.C., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAFFUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-338-2084
Mailing Address - Street 1:187 PINE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4527
Mailing Address - Country:US
Mailing Address - Phone:845-338-2084
Mailing Address - Fax:845-334-9343
Practice Address - Street 1:187 PINE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4527
Practice Address - Country:US
Practice Address - Phone:845-338-2084
Practice Address - Fax:845-334-9343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty