Provider Demographics
NPI:1275671018
Name:PUCCI, DOUGLAS JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JOSEPH
Last Name:PUCCI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 ORADELL AVE
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1732
Mailing Address - Country:US
Mailing Address - Phone:201-261-5430
Mailing Address - Fax:201-261-0972
Practice Address - Street 1:617 ORADELL AVE
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1732
Practice Address - Country:US
Practice Address - Phone:201-261-5430
Practice Address - Fax:201-261-0972
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00346400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ650470Medicare PIN
NJU11117Medicare UPIN