Healthcare Provider Details

I. General information

NPI: 1194404145
Provider Name (Legal Business Name): MARIA CUCURILLO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 CENTRE AVE
BELLMORE NY
11710-3421
US

IV. Provider business mailing address

2090 CENTRE AVE
BELLMORE NY
11710-3421
US

V. Phone/Fax

Practice location:
  • Phone: 516-455-8572
  • Fax:
Mailing address:
  • Phone: 516-455-8572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number009564-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: