Provider Demographics
NPI:1124333471
Name:PUCCINI, IDA (RN)
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:
Last Name:PUCCINI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2371 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4042
Mailing Address - Country:US
Mailing Address - Phone:516-221-6935
Mailing Address - Fax:516-221-6937
Practice Address - Street 1:2371 HUDSON ST
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4042
Practice Address - Country:US
Practice Address - Phone:516-221-6935
Practice Address - Fax:516-221-6937
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY631075163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse