Healthcare Provider Details

I. General information

NPI: 1184301657
Provider Name (Legal Business Name): GRETA PUCCI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 E TREMONT AVE
BRONX NY
10460-4171
US

IV. Provider business mailing address

815 E TREMONT AVE
BRONX NY
10460-4171
US

V. Phone/Fax

Practice location:
  • Phone: 917-891-8800
  • Fax:
Mailing address:
  • Phone: 845-596-2189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberRT009894-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: