Healthcare Provider Details

I. General information

NPI: 1528319498
Provider Name (Legal Business Name): LISA M MASCHERINO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9579 VOCATIONAL DR
PAINTED POST NY
14870-9043
US

IV. Provider business mailing address

8 ROBIE ST
BATH NY
14810-1130
US

V. Phone/Fax

Practice location:
  • Phone: 607-739-3581
  • Fax:
Mailing address:
  • Phone: 607-368-3114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number22 552657
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: