MEDICARE: DR. PAUL NUCCIO DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X005234	NY

General Provider Information

NPI Number	:	1164512919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL NUCCIO DC

Provider Business Mailing Address
First Line	:	2089 GRAND AVE
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-2916
Country	:	US
Telephone Number	:	516-623-2100
Fax Number	:	516-623-0513

Provider Business Practice Location Address
First Line	:	2089 GRAND AVE
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-2916
Country	:	US
Telephone Number	:	516-623-2100
Fax Number	:	516-623-0513

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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