Provider Demographics
NPI:1992792915
Name:VACCARI, MARIA E (DO)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:E
Last Name:VACCARI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2734
Mailing Address - Country:US
Mailing Address - Phone:631-969-4590
Mailing Address - Fax:631-647-7690
Practice Address - Street 1:220 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2734
Practice Address - Country:US
Practice Address - Phone:631-969-4590
Practice Address - Fax:631-647-7690
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01497474Medicaid
NY01480120Medicaid
NY01480120Medicaid
F70037Medicare UPIN