Healthcare Provider Details

I. General information

NPI: 1134814528
Provider Name (Legal Business Name): AVRAHAM MARCUCCI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 HUDSON VALLEY AVE
NEW WINDSOR NY
12553-4747
US

IV. Provider business mailing address

5-01 SUMMIT AVE
FAIR LAWN NJ
07410-2163
US

V. Phone/Fax

Practice location:
  • Phone: 845-220-2270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number346700
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: