Healthcare Provider Details

I. General information

NPI: 1023192770
Provider Name (Legal Business Name): TAMI L PUCINO NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMI L BERGMAN NP-C

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3548 US HIGHWAY 9W
HIGHLAND NY
12528
US

IV. Provider business mailing address

3548 US HIGHWAY 9W
HIGHLAND NY
12528-1700
US

V. Phone/Fax

Practice location:
  • Phone: 845-541-9840
  • Fax: 323-375-3799
Mailing address:
  • Phone: 845-541-9840
  • Fax: 323-375-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF334835
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: