Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N003952 | NY |
Y | 222Z00000X | Podiatrist | N003952 | NY |
N | 213EP1101X | Primary Podiatric Medicine | N003952 | NY |
N | 111NR0200X | Radiology | N003952 | NY |
N | 213ER0200X | Radiology | N003952 | NY |
N | 2081S0010X | Sports Medicine | N003952 | NY |
N | 213ES0000X | Sports Medicine | N003952 | NY |
N | 213ES0131X | Foot Surgery | N003952 | NY |
NPI | 1396702486 |
---|---|
Provider Name | Marina A Maulucci |
First Address | Tonawanda, NY 14150-2935 |
Second Address | Tonawanda, NY 14150-2935 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 02/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00010254001 | UNIVERA (01) | NY |
00010254002 | UNIVERA ELLICOTT CREEK OF (01) | NY |
000500995001 | BCBS ALL (01) | NY |
000500995004 | BCBS DME (01) | NY |
00975291 | (05) | NY |
480005207 | MEDICARE RAILROAD (01) | NY |
8905488 | INDEPENDENT HEALTH (01) | NY |
T25951 | (02) | NY |