Provider Demographics
NPI:1497996359
Name:ADVANCED LAPAROSCOPIC SPECIALISTS LLC
Entity Type:Organization
Organization Name:ADVANCED LAPAROSCOPIC SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:845-368-1500
Mailing Address - Street 1:11 N AIRMONT RD
Mailing Address - Street 2:SUITE A10
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-5103
Mailing Address - Country:US
Mailing Address - Phone:845-368-1500
Mailing Address - Fax:845-368-1501
Practice Address - Street 1:11 N AIRMONT RD
Practice Address - Street 2:SUITE A10
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5103
Practice Address - Country:US
Practice Address - Phone:845-368-1500
Practice Address - Fax:845-368-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty