Healthcare Provider Details

I. General information

NPI: 1336063585
Provider Name (Legal Business Name): ERIC JAMES BUCCO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 ASPINWALL ST
STATEN ISLAND NY
10307-2100
US

IV. Provider business mailing address

212 ASPINWALL ST
STATEN ISLAND NY
10307-2100
US

V. Phone/Fax

Practice location:
  • Phone: 718-772-4898
  • Fax:
Mailing address:
  • Phone: 718-772-4898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number433745
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: