Joseph William Boccio, LPN

Individual provider Active NPI Licensed Practical Nurse · Centereach, NY

NPI 1245583202 · NPPES record last updated Oct 16, 2012

Key facts

NPI
1245583202
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
311226 (NY)
Practice address
130 S Coleman Rd
Centereach, NY 11720-4410
Phone
(631) 559-2112
Fax
(631) 471-4487
NPI assigned
Oct 16, 2012
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
311226NYMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 311226 NY Yes

Addresses

Primary practice location

130 S Coleman Rd
Centereach, NY 11720-4410

Mailing address

130 S Coleman Rd
Centereach, NY 11720-4410
Phone (631) 559-2112

Other providers in Centereach, NY

All providers in Centereach, NY · Licensed Practical Nurse in New York

Sources for this page

Verify at the official NPI Registry.