Provider Demographics
NPI:1346401205
Name:CUCCHIARA, VITA MIA
Entity Type:Individual
Prefix:DR
First Name:VITA
Middle Name:MIA
Last Name:CUCCHIARA
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 1:300 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4198
Mailing Address - Country:US
Mailing Address - Phone:516-280-2599
Mailing Address - Fax:516-280-2597
Practice Address - Street 1:300 OLD COUNTRY RD
Practice Address - Street 2:SUITE 211
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4198
Practice Address - Country:US
Practice Address - Phone:516-280-2599
Practice Address - Fax:516-280-2597
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine