Healthcare Provider Details

I. General information

NPI: 1376817353
Provider Name (Legal Business Name): LUCILLE CUOMO R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 BELL BLVD 3RD FLOOR
BAYSIDE NY
11364-3448
US

IV. Provider business mailing address

7525 BELL BLVD 3RD FLOOR
BAYSIDE NY
11364-3448
US

V. Phone/Fax

Practice location:
  • Phone: 718-464-5776
  • Fax: 718-464-2268
Mailing address:
  • Phone: 718-464-5776
  • Fax: 718-464-2268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number258487-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: