Healthcare Provider Details

I. General information

NPI: 1760547202
Provider Name (Legal Business Name): JAMES GUCCIARDI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 S JERSEY AVE
EAST SETAUKET NY
11733-2045
US

IV. Provider business mailing address

PO BOX 202
SAINT JAMES NY
11780-0202
US

V. Phone/Fax

Practice location:
  • Phone: 631-675-2758
  • Fax: 631-675-2760
Mailing address:
  • Phone: 631-675-2758
  • Fax: 631-675-2760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX010407-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: