1265421671 NPI number — MR. JOSEPH A MUCCIO PT

Table of content: MR. JOSEPH A MUCCIO PT (NPI 1265421671)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265421671 NPI number — MR. JOSEPH A MUCCIO PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUCCIO
Provider First Name:
JOSEPH
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265421671
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 E MARKET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44481-1206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-399-2221
Provider Business Mailing Address Fax Number:
330-394-0122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 YOUNGSTOWN WARREN RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
NILES
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44446-4644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-652-2403
Provider Business Practice Location Address Fax Number:
330-652-2409
Provider Enumeration Date:
10/18/2005

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: 225100000X , with the licence number:  PT-1760 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0222253 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com