Healthcare Provider Details

I. General information

NPI: 1588480073
Provider Name (Legal Business Name): DEAN CUCURULLO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2024
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 ROBBINS LN
SYOSSET NY
11791-6005
US

IV. Provider business mailing address

1197 SYLVIA RD
SEAFORD NY
11783-1536
US

V. Phone/Fax

Practice location:
  • Phone: 212-439-1596
  • Fax:
Mailing address:
  • Phone: 516-318-7318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number053192
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: