Provider Demographics
NPI:1053558965
Name:FRANCAVILLA, MARIA N (PT)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:N
Last Name:FRANCAVILLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:N
Other - Last Name:MATRECANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 140814
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-0814
Mailing Address - Country:US
Mailing Address - Phone:718-494-1111
Mailing Address - Fax:718-477-5739
Practice Address - Street 1:468 S GANNON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7610
Practice Address - Country:US
Practice Address - Phone:718-494-1111
Practice Address - Fax:718-477-5739
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009357172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY264019327OtherEIN