Provider Demographics
NPI:1124381736
Name:LUCCHINI, NINAMARIE (MSED)
Entity Type:Individual
Prefix:
First Name:NINAMARIE
Middle Name:
Last Name:LUCCHINI
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1348
Mailing Address - Country:US
Mailing Address - Phone:718-816-8840
Mailing Address - Fax:
Practice Address - Street 1:124 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1348
Practice Address - Country:US
Practice Address - Phone:718-816-8840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist