Healthcare Provider Details

I. General information

NPI: 1649411331
Provider Name (Legal Business Name): JAMES VINCENT MAURO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 W AMES CT SUITE 200
PLAINVIEW NY
11803-2304
US

IV. Provider business mailing address

55 W AMES CT SUITE 200
PLAINVIEW NY
11803-2304
US

V. Phone/Fax

Practice location:
  • Phone: 516-938-8080
  • Fax: 866-434-8455
Mailing address:
  • Phone: 516-938-8080
  • Fax: 866-434-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number027093
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: