Healthcare Provider Details

I. General information

NPI: 1619402856
Provider Name (Legal Business Name): JUSTIN TUCCIARONE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 BROADWAY
NEW YORK NY
10012-2327
US

IV. Provider business mailing address

654 BROADWAY
NEW YORK NY
10012-2327
US

V. Phone/Fax

Practice location:
  • Phone: 646-647-1251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: