Healthcare Provider Details

I. General information

NPI: 1255294120
Provider Name (Legal Business Name): MAC TRAVELS NYC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2025
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 W 11TH ST
DEER PARK NY
11729-6407
US

IV. Provider business mailing address

290 W 11TH ST
DEER PARK NY
11729-6407
US

V. Phone/Fax

Practice location:
  • Phone: 929-219-7129
  • Fax:
Mailing address:
  • Phone: 929-219-7129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State

VIII. Authorized Official

Name: MELISSA ANN CAPPAS
Title or Position: LPN
Credential:
Phone: 929-219-7129