MEDICARE: MS. MARCI JONES MACALUSO SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	008249	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	008249	OTHER	NY	NEW YORK STATE

General Provider Information

NPI Number	:	1659525343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCI JONES MACALUSO SLP

Provider Business Mailing Address
First Line	:	27 LAKE SHORE DR
Second Line	:
City	:	SOUTH SALEM
State	:	NY
Zip	:	10590-1311
Country	:	US
Telephone Number	:	914-763-2472
Fax Number	:	212-213-6332

Provider Business Practice Location Address
First Line	:	27 LAKE SHORE DR
Second Line	:
City	:	SOUTH SALEM
State	:	NY
Zip	:	10590-1311
Country	:	US
Telephone Number	:	914-763-2472
Fax Number	:	212-213-6332

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2008
Last Update Date	:	11/08/2008

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