Provider Demographics
NPI:1639127053
Name:BOCCIO, RICHARD (MD DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BOCCIO
Suffix:
Gender:M
Credentials:MD DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 EAST MAIN STREET
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:631-265-6991
Mailing Address - Fax:631-366-3290
Practice Address - Street 1:290 EAST MAIN STREET
Practice Address - Street 2:SUITE 700
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-265-6991
Practice Address - Fax:631-366-3290
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1726592207X00000X
NYN0033481213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
E94868Medicare UPIN
NYP51221Medicare PIN
NY97F05ZYWX1Medicare PIN
NY97F051Medicare PIN