Healthcare Provider Details

I. General information

NPI: 1750668612
Provider Name (Legal Business Name): LAUREN MARIE HSU MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN MARIE MACCHIA MS, ATC

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 WHEELER RD ATTN: ATHLETIC OFFICE
CENTRAL ISLIP NY
11722-2018
US

IV. Provider business mailing address

94 ONTARIO ST
PORT JEFFERSON STATION NY
11776-4352
US

V. Phone/Fax

Practice location:
  • Phone: 631-348-5017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000433-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: