Doctor Name: | PAUL J FUCCILLO |
NPI Number: | 1821437492 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.AC. LMT MS MA |
License Number: | 024021 |
Business Practice Address: | 28 Birchwood Dr Huntington Station, NY - 117463902 |
Business Phone Number: | 6312233385 |
Business Fax Number: | |
Mailing Address: | 28 Birchwood Dr, HUNTINGTON STATION |
State: | NY |
Postal Code: | 117463902 |
Phone Number: | 6312233385 |
Fax Number: | |
NPI Enumeration Date: | 06/17/2013 |
NPI Last Update Date: | 06/18/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 024021 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NY |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |