Provider Demographics
NPI:1023178621
Name:CANDIDA CATUCCI MD PC
Entity Type:Organization
Organization Name:CANDIDA CATUCCI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CANDIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CATUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-565-6565
Mailing Address - Street 1:4008 FORLEY ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1427
Mailing Address - Country:US
Mailing Address - Phone:718-565-6565
Mailing Address - Fax:718-565-6999
Practice Address - Street 1:4008 FORLEY ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1427
Practice Address - Country:US
Practice Address - Phone:718-565-6565
Practice Address - Fax:718-565-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06825Medicare PIN