Peconic Urology P.C.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

148353 Issued in NY

Legal business name

PECONIC UROLOGY P.C.

Practice address

20 Hicksville Rd
Suite 3
Massapequa, NY 11758-5819

Phone

(516) 541-5500

Fax

(516) 541-5199

NPI assigned

Mar 16, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert L Mucciolo, M.DNPI 1245334473

Title

President

Phone

(516) 541-5500

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert L Mucciolo, M.D.

  • Urology Physician
  • Massapequa, NY
  • NPI 1245334473
  NPD (past) Authorized official
• Marjorie J. Isdith, D.O.

  • Family Medicine Physician
  • Massapequa, NY
  • NPI 1205831435
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003940248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 HICKSVILLE RD",
            "address_2": "SUITE 3",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117585819",
            "telephone_number": "516-541-5500",
            "fax_number": "516-541-5199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 HICKSVILLE RD",
            "address_2": "SUITE 3",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117585819",
            "telephone_number": "516-541-5500",
            "fax_number": "516-541-5199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PECONIC UROLOGY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MUCCIOLO",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-541-5500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "NY",
            "license": "148353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mital B. Patel, D.P.M.
• Pathmark Stores Inc
• Paul B Bernstein DPM PC
• Ana V. Payano, FNP
• Logan Emily Peckman, COTA/L
• Peddycoart NP in Family Healthp C
• Danielle Peddycoart
• Ann Marie Chan Pelayre, PT
• Laura Anne Pellegrino, NP
• Jennine Perez-Hargrove, LPN

• Urology Physician in Massapequa, NY
• Providers in Massapequa, NY by specialty
• Urology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.