Healthcare Provider Details

I. General information

NPI: 1790783272
Provider Name (Legal Business Name): JOHN J CUCINOTTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 IRVING AVE
SYRACUSE NY
13210-1687
US

IV. Provider business mailing address

5008 BRITTONFIELD PKWY SUITE 100
EAST SYRACUSE NY
13057-9248
US

V. Phone/Fax

Practice location:
  • Phone: 315-470-7551
  • Fax: 315-470-2719
Mailing address:
  • Phone: 315-234-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number134680
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number134680
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: