Provider Demographics
NPI:1811919814
Name:BUCCELLATO, JOHN J (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:BUCCELLATO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1345 RXR PLZ FL 13
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556-1301
Mailing Address - Country:US
Mailing Address - Phone:516-453-0435
Mailing Address - Fax:646-846-3283
Practice Address - Street 1:1500 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7349
Practice Address - Country:US
Practice Address - Phone:212-710-1065
Practice Address - Fax:212-736-3229
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2019-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY181208207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01277018Medicaid
F20512Medicare UPIN
NY01277018Medicaid