Healthcare Provider Details

I. General information

NPI: 1376462366
Provider Name (Legal Business Name): CHRISTIAN COTUMACCIO LCAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 HIGBIE LN FL 1
WEST ISLIP NY
11795-2828
US

IV. Provider business mailing address

14 GAILVIEW DR
OYSTER BAY NY
11771-3603
US

V. Phone/Fax

Practice location:
  • Phone: 631-867-2501
  • Fax:
Mailing address:
  • Phone: 631-867-2501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number003172
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: