1366777963 NPI number — JANICE IANNUCCI NURSE PRACTITIONER

Table of content: JANICE IANNUCCI NURSE PRACTITIONER (NPI 1366777963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366777963 NPI number — JANICE IANNUCCI NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IANNUCCI
Provider First Name:
JANICE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IANNUCCI
Provider Other First Name:
JANICE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
NURSE PRACTITIONER
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1366777963
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
71 N BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HICKSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11801-2942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-938-0020
Provider Business Mailing Address Fax Number:
516-470-1475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71 N BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HICKSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11801-2942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-938-0020
Provider Business Practice Location Address Fax Number:
516-470-1475
Provider Enumeration Date:
10/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  F304305 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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