Healthcare Provider Details

I. General information

NPI: 1033030515
Provider Name (Legal Business Name): MR. RICHARD DYLAN CUCCURULLO I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7855 BOULEVARD E APT 8F
NORTH BERGEN NJ
07047-5928
US

IV. Provider business mailing address

7855 BOULEVARD E APT 8F
NORTH BERGEN NJ
07047-5928
US

V. Phone/Fax

Practice location:
  • Phone: 646-271-5223
  • Fax:
Mailing address:
  • Phone: 646-271-5223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number410449
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: