Provider Demographics
NPI:1124421961
Name:MAGLIACANO, LYNN (LPN)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:MAGLIACANO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HANSBURG ROAD
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566
Mailing Address - Country:US
Mailing Address - Phone:845-346-5397
Mailing Address - Fax:845-210-1175
Practice Address - Street 1:120 HANSBURG RD
Practice Address - Street 2:
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566-5008
Practice Address - Country:US
Practice Address - Phone:845-346-5397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186698-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse