Provider Demographics
NPI:1073824454
Name:GRUCCI, FELIX JAMES III (DO)
Entity Type:Individual
Prefix:DR
First Name:FELIX
Middle Name:JAMES
Last Name:GRUCCI
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:101 HOSPITAL RD UNIT 1E
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4870
Mailing Address - Country:US
Mailing Address - Phone:631-654-7760
Mailing Address - Fax:631-447-3053
Practice Address - Street 1:101 HOSPITAL ROAD
Practice Address - Street 2:ACCESS CENTER
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4870
Practice Address - Country:US
Practice Address - Phone:631-654-7760
Practice Address - Fax:631-447-3044
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13068204D00000X, 2084P0800X, 2084P0800X
NY286656204D00000X, 2084P0800X
AZR18312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY286656-4WOtherWORKER'S COMPENSATION
NY04672437Medicaid
FL110890100Medicaid