Provider Demographics
NPI:1598725665
Name:PICCIONE, RICHARD (RPAC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:PICCIONE
Suffix:
Gender:M
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-6003
Mailing Address - Country:US
Mailing Address - Phone:631-422-9355
Mailing Address - Fax:631-669-8763
Practice Address - Street 1:580 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-6003
Practice Address - Country:US
Practice Address - Phone:631-422-9355
Practice Address - Fax:631-669-8763
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002592363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002592OtherLICENSE
NY002592OtherLICENSE