Provider Demographics
NPI:1992968101
Name:TUCCI, FREDERICK MICHAEL (DPM)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:MICHAEL
Last Name:TUCCI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 09 75TH ST
Mailing Address - Street 2:MIDDLE VILLAGE
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11379
Mailing Address - Country:US
Mailing Address - Phone:516-997-8345
Mailing Address - Fax:516-997-0105
Practice Address - Street 1:67 09 75TH ST
Practice Address - Street 2:MIDDLE VILLAGE
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11379
Practice Address - Country:US
Practice Address - Phone:516-997-8345
Practice Address - Fax:516-997-0105
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002633213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist