Healthcare Provider Details

I. General information

NPI: 1952735847
Provider Name (Legal Business Name): LAURA B MACCONE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 602
HACKENSACK NJ
07601-1962
US

IV. Provider business mailing address

20 PROSPECT AVE STE 602
HACKENSACK NJ
07601-1962
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2442
  • Fax:
Mailing address:
  • Phone: 551-206-1338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00457400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: