Individual
MICHAEL PAUL FANUCCHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
19 BRADHURST AVE STE 2300N, HAWTHORNE, NY 10532-2140
(914) 909-9018
(914) 493-2416
Mailing address
19 BRADHURST AVENUE, SUITE 3100N, HAWTHORNE, NY 10523-6007
(914) 909-9018
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
139415
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02913308
—
NY
Enumeration date
08/23/2006
Last updated
10/24/2025
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