Provider Demographics
NPI:1346062122
Name:MUECKENHEIM, TODD BRANDON
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:BRANDON
Last Name:MUECKENHEIM
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 1:417 E MAIN ST APT X1
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8530
Mailing Address - Country:US
Mailing Address - Phone:203-807-4460
Mailing Address - Fax:
Practice Address - Street 1:105 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1821
Practice Address - Country:US
Practice Address - Phone:203-807-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach