Jaclyn Roseann Cuccinello, NP

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

F421258-1 Issued in NY

Practice address

5225 Rte 347 Ste 70
Port Jefferson Station, NY 11776-2061

Phone

(631) 331-8777

Fax

(631) 474-9169

NPI assigned

Aug 6, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/
• Direct secure messaging: jaclyn.cuccinello.1@1427.direct.athenahealth.com
• Direct secure messaging: jaclyn.cuccinello@sbcm.cernerdirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Argen-Medical, PLLC

  • Obstetrics & Gynecology Physician
  • Port Jefferson Station, NY
  • NPI 1235361643
  NPD

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

{
    "created_epoch": "1217980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562803200000",
    "number": "1043476237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5225 RTE 347 STE 70",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117762061",
            "telephone_number": "631-331-8777",
            "fax_number": "631-474-9169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5225 RTE 347 STE 70",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117762061",
            "telephone_number": "631-331-8777",
            "fax_number": "631-474-9169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUCCINELLO",
        "first_name": "JACLYN",
        "middle_name": "ROSEANN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-06",
        "last_updated": "2019-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "565107",
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "NY",
            "license": "F421258-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "565107",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lynn.goldstein@sbadministrativeservices.org",
            "affiliation": "N",
            "address_1": "5225 Rte 347 Ste 70",
            "city": "Port Jefferson Station",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117762061",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jennifer Elizabeth Crabbe, LMSW
• Michelle Crain, LPN
• Lisa Crocco
• Kerry A Cronin, M.D.
• Stephen J Crovello, LCSW PC
• Custom TRT US Inc
• Jesa Kiana Cuyugan
• CVS Albany LLC
• George Cyriac, M.D.
• Nicole D'Angelo

• Women's Health Nurse Practitioner in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Women's Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; 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.