Provider Demographics
NPI:1740457712
Name:PRAINITO, MAURIZIO SERGIO
Entity type:Individual
Prefix:
First Name:MAURIZIO
Middle Name:SERGIO
Last Name:PRAINITO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 157TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3237
Mailing Address - Country:US
Mailing Address - Phone:917-838-0942
Mailing Address - Fax:
Practice Address - Street 1:2412 34TH AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-4320
Practice Address - Country:US
Practice Address - Phone:718-383-3882
Practice Address - Fax:718-383-3886
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist