Provider Demographics
NPI:1316947211
Name:MUCCI, WAYNE
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:MUCCI
Suffix:
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 1:2007 PALM BEACH LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6501
Mailing Address - Country:US
Mailing Address - Phone:561-420-8555
Mailing Address - Fax:561-420-8550
Practice Address - Street 1:2007 PALM BEACH LAKES BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6501
Practice Address - Country:US
Practice Address - Phone:561-420-8555
Practice Address - Fax:561-420-8550
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05189600174400000X
FLOS5584207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4383941OtherAETNA PPO #
NJ0519349000OtherAMERIHEALTH #
NJ2692811OtherAETNA HMO #
NJ5009201Medicaid
NJ223762143OtherTAX IDENTIFICATION #
NJ2K1863OtherHEALTHNET #
NJGLS035OtherOXFORD #
NJ2K1863OtherHEALTHNET #
NJ0519349000OtherAMERIHEALTH #