Provider Demographics
NPI:1235756859
Name:PASCUCCI, VICKI ELIZABETH
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:ELIZABETH
Last Name:PASCUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 1/2 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-3616
Mailing Address - Country:US
Mailing Address - Phone:585-933-0686
Mailing Address - Fax:
Practice Address - Street 1:324 1/2 S UNION ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-3616
Practice Address - Country:US
Practice Address - Phone:585-933-0686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202004265347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY202004265OtherBUSINESS LICENSE NUMBER