Provider Demographics
NPI:1245583202
Name:BOCCIO, JOSEPH WILLIAM (LPN)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:BOCCIO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S COLEMAN RD
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-4410
Mailing Address - Country:US
Mailing Address - Phone:631-559-2112
Mailing Address - Fax:631-471-4487
Practice Address - Street 1:130 S COLEMAN RD
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-4410
Practice Address - Country:US
Practice Address - Phone:631-559-2112
Practice Address - Fax:631-471-4487
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311226164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse