Healthcare Provider Details

I. General information

NPI: 1609851211
Provider Name (Legal Business Name): JAMES DUCEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SEAVIEW AVE
STATEN ISLAND NY
10305-3401
US

IV. Provider business mailing address

1 EDGEWATER ST PAYER RELATIONS DEPARTMENT
STATEN ISLAND NY
10305-4907
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-8662
  • Fax:
Mailing address:
  • Phone: 718-226-4324
  • Fax: 718-226-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number153995
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: