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Contact Information

JACLYN R CUCCINELLO, NP
5225 RTE 347 STE 70
PORT JEFFERSON STATION, NY11776-2061
 Phone: 631-331-8777
 Fax: 631-474-9169
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Women's Health

363LW0102X 50 Nurse Practitioner
 

Registered Nurse

163W00000X
Indicates primary specialty

NPI Profile & details for JACLYN R CUCCINELLO · (Female)

NPI Number 1043476237
Status Active
Credentials NP (Nurse Practitioner)
Entity Individual
Enumeration date 08/06/2008
Last updated 07/11/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • NY License # 565107
  • NY License # F421258-1
  • NY Medicaid 565107
Hospital affiliation(s)
  • JOHN T MATHER MEMORIAL HOSPITAL OF PORT JEFFERSON - (Acute Care)
    75 NORTH COUNTRY ROAD
    PORT JEFFERSON, NY 11777
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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