Healthcare Provider Details

I. General information

NPI: 1871904193
Provider Name (Legal Business Name): MARTHA MACALUSO MLT, RDH BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1181 OLD COUNTRY RD
PLAINVIEW NY
11803-5018
US

IV. Provider business mailing address

512 N NEWBRIDGE RD
LEVITTOWN NY
11756-1602
US

V. Phone/Fax

Practice location:
  • Phone: 516-932-3050
  • Fax:
Mailing address:
  • Phone: 516-850-4625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number024448-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number024448-1
License Number StateNY

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: