Healthcare Provider Details

I. General information

NPI: 1902893340
Provider Name (Legal Business Name): MICHAEL GUCCIONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3322 BAINBRIDGE AVE
BRONX NY
10467-2849
US

IV. Provider business mailing address

PO BOX 1042 PO BOX 1042
RIDGEFIELD CT
06877-9042
US

V. Phone/Fax

Practice location:
  • Phone: 718-881-2100
  • Fax: 718-881-5164
Mailing address:
  • Phone: 718-881-2100
  • Fax: 718-881-5164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number211368
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: