=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790205334
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NIKI MARIE CUCCHI FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2017
-----------------------------------------------------
Last Update Date | 11/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 MURRAY ST
-----------------------------------------------------
City | GLENS FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12801-4311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-636-5284
-----------------------------------------------------
Fax | 518-320-7245
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 MURRAY ST
-----------------------------------------------------
City | GLENS FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12801-4311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-636-5284
-----------------------------------------------------
Fax | 518-320-7245
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | F341878-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | F341878-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------