Healthcare Provider Details

I. General information

NPI: 1821741612
Provider Name (Legal Business Name): JANNA CUPID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 216TH ST
BAYSIDE NY
11360-2810
US

IV. Provider business mailing address

709 E 52ND ST
BROOKLYN NY
11203-5903
US

V. Phone/Fax

Practice location:
  • Phone: 631-844-4809
  • Fax:
Mailing address:
  • Phone: 347-452-5759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: