Provider Demographics
NPI:1861571549
Name:MAUCERI, JOSEPH M (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:MAUCERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 JOHN F KENNEDY DR
Mailing Address - Street 2:SUITE 134
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1141
Mailing Address - Country:US
Mailing Address - Phone:561-439-0308
Mailing Address - Fax:561-439-0371
Practice Address - Street 1:130 JOHN F KENNEDY DR
Practice Address - Street 2:SUITE 134
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33462-1141
Practice Address - Country:US
Practice Address - Phone:561-439-0308
Practice Address - Fax:561-439-0371
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0017219174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB18723Medicare UPIN
NY694331Medicare ID - Type Unspecified