Provider Demographics
NPI:1669708459
Name:MACA, LUDY ANNE
Entity type:Individual
Prefix:MRS
First Name:LUDY ANNE
Middle Name:
Last Name:MACA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUDY ANNE
Other - Middle Name:
Other - Last Name:FELICIANO-MACA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:137 BUCKINGHAM PL
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1954
Mailing Address - Country:US
Mailing Address - Phone:917-400-2528
Mailing Address - Fax:
Practice Address - Street 1:137 BUCKINGHAM PL
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1954
Practice Address - Country:US
Practice Address - Phone:917-400-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023103-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist