Healthcare Provider Details

I. General information

NPI: 1598731879
Provider Name (Legal Business Name): PATRICIA ANNE CUCOLO MD, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 FAIRVIEW DR S
BASKING RIDGE NJ
07920-2326
US

IV. Provider business mailing address

105 FAIRVIEW DR S
BASKING RIDGE NJ
07920-2326
US

V. Phone/Fax

Practice location:
  • Phone: 908-334-1936
  • Fax:
Mailing address:
  • Phone: 908-334-1936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA06989000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-319049
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: