Healthcare Provider Details

I. General information

NPI: 1568529675
Provider Name (Legal Business Name): ROBERT LOUIS CUCIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 11/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 S FLAGLER DR SUITE 607
WEST PALM BEACH FL
33401-7341
US

IV. Provider business mailing address

1701 S FLAGLER DR SUITE 607
WEST PALM BEACH FL
33401-7341
US

V. Phone/Fax

Practice location:
  • Phone: 561-651-7816
  • Fax: 561-651-7808
Mailing address:
  • Phone: 212-586-9500
  • Fax: 561-651-7808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number114103
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: