Provider Demographics
NPI:1972727295
Name:PUCCIA, VINCENT A (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:A
Last Name:PUCCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3229 162ND ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1324
Mailing Address - Country:US
Mailing Address - Phone:718-353-8441
Mailing Address - Fax:718-359-8919
Practice Address - Street 1:3229 162ND ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1324
Practice Address - Country:US
Practice Address - Phone:718-353-8441
Practice Address - Fax:718-359-8919
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182488207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01299196Medicaid
NY00254Medicare PIN
NY01299196Medicaid