MEDICARE: LISA A. MEGNA-VICINANZO DC PC

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	111N00000X	Chiropractor	X006345-1	NY

General Provider Information

NPI Number	:	1740498781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA A. MEGNA-VICINANZO DC PC

Provider Business Mailing Address
First Line	:	959 WASHINGTON AVENUE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12206
Country	:	US
Telephone Number	:	518-489-4811
Fax Number	:

Provider Business Practice Location Address
First Line	:	959 WASHINGTON AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12206-1415
Country	:	US
Telephone Number	:	518-489-4811
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. LISA A MEGNA-VICINANZO
Credential	:	DC
Telephone Number	:	516-489-4811

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	08/22/2020

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