Provider Demographics
NPI:1932194735
Name:MACIAG, MARY BETH (NP)
Entity Type:Individual
Prefix:MS
First Name:MARY BETH
Middle Name:
Last Name:MACIAG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-1529
Mailing Address - Country:US
Mailing Address - Phone:908-852-2605
Mailing Address - Fax:908-852-2605
Practice Address - Street 1:196 SPEEDWELL AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-2934
Practice Address - Country:US
Practice Address - Phone:973-539-1364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-18
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN06791200363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health