Healthcare Provider Details

I. General information

NPI: 1750968251
Provider Name (Legal Business Name): MARIA COLUCCIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

703 MAIN ST
PATERSON NJ
07503-2691
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-6700
  • Fax:
Mailing address:
  • Phone: 973-754-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA13214200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: