Healthcare Provider Details

I. General information

NPI: 1114941325
Provider Name (Legal Business Name): CHRISTOPHER CUCCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 WEST 4TH STREET MOUNT VERNON NEIGHBORHOOD HEALTH CTR
MOUNT VERNON NY
10550
US

IV. Provider business mailing address

107 WEST 4TH STREET MOUNT VERNON NEIGHBORHOOD HEALTH CTR
MOUNT VERNON NY
10550
US

V. Phone/Fax

Practice location:
  • Phone: 914-699-7200
  • Fax: 914-699-0837
Mailing address:
  • Phone: 914-699-7200
  • Fax: 914-699-0837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number240054-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: