Provider Demographics
NPI:1467654822
Name:CUCCINIELLO, MICHAEL F (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:CUCCINIELLO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1782
Mailing Address - Street 2:
Mailing Address - City:QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11959-1782
Mailing Address - Country:US
Mailing Address - Phone:631-653-6112
Mailing Address - Fax:631-653-5899
Practice Address - Street 1:25 MONTAUK HWY.
Practice Address - Street 2:
Practice Address - City:QUOGUE
Practice Address - State:NY
Practice Address - Zip Code:11959-1782
Practice Address - Country:US
Practice Address - Phone:631-653-6112
Practice Address - Fax:631-653-5899
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328551-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered