Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 286656 | NY |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS13068 | FL |
NPI | 1073824454 |
---|---|
Provider Name | Dr. Felix James Grucci III |
First Address | Patchogue, NY 11772-4870 |
Second Address | Patchogue, NY 11772-4870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2010 |
Last Update Date | 10/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04672437 | (05) | NY |
286656-4W | WORKER'S COMPENSATION (01) | NY |