Provider Demographics
NPI:1518078930
Name:CUCRIO, JOSEPH ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANDREW
Last Name:CUCRIO
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 1:416 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3841
Mailing Address - Country:US
Mailing Address - Phone:631-751-5501
Mailing Address - Fax:631-751-5502
Practice Address - Street 1:416 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3841
Practice Address - Country:US
Practice Address - Phone:631-751-5501
Practice Address - Fax:631-751-5502
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0000691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
X02781Medicare ID - Type Unspecified