Healthcare Provider Details

I. General information

NPI: 1437605607
Provider Name (Legal Business Name): JOHN CUCUZZA TEACHER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 4TH AVE APARTMENT 7D
BROOKLYN NY
11215-6363
US

IV. Provider business mailing address

574 4TH AVE APARTMENT 7D
BROOKLYN NY
11215-6363
US

V. Phone/Fax

Practice location:
  • Phone: 917-647-2238
  • Fax: 347-384-2797
Mailing address:
  • Phone: 917-647-2238
  • Fax: 347-384-2797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: