Healthcare Provider Details

I. General information

NPI: 1295559748
Provider Name (Legal Business Name): MACORIS SELFCARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

978 ROUTE 45 STE 100
POMONA NY
10970-3512
US

IV. Provider business mailing address

10 S CONSTITUTION DR
TAPPAN NY
10983-1619
US

V. Phone/Fax

Practice location:
  • Phone: 845-274-0256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA REYNOSO-CALDERON
Title or Position: OWNER
Credential: MD
Phone: 845-274-0256