Healthcare Provider Details

I. General information

NPI: 1114249935
Provider Name (Legal Business Name): JANICE CECCUCCI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2010
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 CHURCH ST
SARATOGA SPRINGS NY
12866-1003
US

IV. Provider business mailing address

211 CHURCH ST
SARATOGA SPRINGS NY
12866-1003
US

V. Phone/Fax

Practice location:
  • Phone: 518-587-1141
  • Fax: 518-399-6428
Mailing address:
  • Phone: 518-587-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number336178
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: