Provider Demographics
NPI:1023393493
Name:ROBERT MUCCIOLO MD PC
Entity Type:Organization
Organization Name:ROBERT MUCCIOLO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:MUCCIOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-541-5500
Mailing Address - Street 1:20 HICKSVILLE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5819
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 HICKSVILLE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5819
Practice Address - Country:US
Practice Address - Phone:516-541-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty