Cuccinello, Jaclyn Roseann

Cuccinello, Jaclyn Roseann is an individual health care provider with primary practice located at 5225 Rte 347 Ste 70 , Port Jefferson Station NY 11776-2061. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Women's Health. Physician Assistants & Advanced Practice Nursing Providers / Women's Health is her primary health care specialty. Cuccinello, Jaclyn Roseann can be contacted via phone (631) 331-8777.

Contact Information

Primary practice address
5225 Rte 347 Ste 70 Port Jefferson Station NY 11776-2061
Phone: (631) 331-8777
Fax: (631) 474-9169
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 565107 New York
Physician Assistants & Advanced Practice Nursing Providers / Women's Health 363LW0102X F421258-1 New York

Profile Details

NPI number 1043476237
LBN Legal business name Cuccinello, Jaclyn Roseann
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 6th, 2008
Last updated Jul 11th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043476237 NPPES
New York MEDICAID 565107

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