Provider Demographics
NPI:1932163250
Name:MACINA, LUCY O (MD,)
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:O
Last Name:MACINA
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 STATION PLZ N
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3808
Mailing Address - Country:US
Mailing Address - Phone:516-663-2588
Mailing Address - Fax:516-663-4644
Practice Address - Street 1:222 STATION PLZ N
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3808
Practice Address - Country:US
Practice Address - Phone:516-663-2588
Practice Address - Fax:516-663-4644
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1626162173000000X
NY8591830207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01199788Medicaid
NY01199788Medicaid
NY30F481Medicare ID - Type Unspecified