Provider Demographics
NPI:1700244977
Name:MACOON, BIBI (MS,ED SBL)
Entity Type:Individual
Prefix:
First Name:BIBI
Middle Name:
Last Name:MACOON
Suffix:
Gender:F
Credentials:MS,ED SBL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63-25 DRY HARBOR ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379
Mailing Address - Country:US
Mailing Address - Phone:646-662-2747
Mailing Address - Fax:
Practice Address - Street 1:63-25 DRY HARBOR ROAD
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379
Practice Address - Country:US
Practice Address - Phone:646-662-2747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist