Provider Demographics
NPI:1831550136
Name:SCORSONE, MARIA VANESSA (LAC)
Entity type:Individual
Prefix:
First Name:MARIA VANESSA
Middle Name:
Last Name:SCORSONE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:SCORSONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:280 MADISON AVE
Mailing Address - Street 2:#508
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0801
Mailing Address - Country:US
Mailing Address - Phone:718-744-4420
Mailing Address - Fax:718-744-4420
Practice Address - Street 1:280 MADISON AVE
Practice Address - Street 2:#508
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0801
Practice Address - Country:US
Practice Address - Phone:718-744-4420
Practice Address - Fax:718-744-4420
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003155-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist