Provider Demographics
NPI:1366761652
Name:MORICCO, JOHN N (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:N
Last Name:MORICCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:216 FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3901
Mailing Address - Country:US
Mailing Address - Phone:516-741-0570
Mailing Address - Fax:516-741-8276
Practice Address - Street 1:216 FIRST STREET
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3901
Practice Address - Country:US
Practice Address - Phone:516-741-0570
Practice Address - Fax:516-741-8276
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252019-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology