Healthcare Provider Details

I. General information

NPI: 1366412116
Provider Name (Legal Business Name): JOHN L LOVECCHIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COMMUNITY DR
MANHASSET NY
11030-3816
US

IV. Provider business mailing address

972 BRUSH HOLLOW RD
WESTBURY NY
11590-1740
US

V. Phone/Fax

Practice location:
  • Phone: 516-562-4438
  • Fax: 516-562-2805
Mailing address:
  • Phone: 516-876-5555
  • Fax: 516-876-5539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number150147
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01140596
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: