Provider Demographics
NPI:1770996613
Name:CASUCCI, VINCENT JOSEPH II (LMT)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:JOSEPH
Last Name:CASUCCI
Suffix:II
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 DUTCHESS TPKE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-6442
Mailing Address - Country:US
Mailing Address - Phone:845-232-3254
Mailing Address - Fax:
Practice Address - Street 1:695 DUTCHESS TPKE
Practice Address - Street 2:SUITE 203
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-6442
Practice Address - Country:US
Practice Address - Phone:845-232-3254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025768174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist