Provider Demographics
NPI:1982461810
Name:MINICUCCI, NICHOLAS III
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:MINICUCCI
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-0516
Mailing Address - Country:US
Mailing Address - Phone:201-226-9104
Mailing Address - Fax:201-587-0218
Practice Address - Street 1:38 5TH ST
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1229
Practice Address - Country:US
Practice Address - Phone:201-226-9104
Practice Address - Fax:201-587-0218
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies