Healthcare Provider Details

I. General information

NPI: 1841465705
Provider Name (Legal Business Name): GINA CUCCURULLO-SCHIAVO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 HEMPSTEAD TPKE SUITE 7
BETHPAGE NY
11714-5711
US

IV. Provider business mailing address

4250 HEMPSTEAD TPKE SUITE 7
BETHPAGE NY
11714-5711
US

V. Phone/Fax

Practice location:
  • Phone: 516-735-3550
  • Fax: 516-735-8067
Mailing address:
  • Phone: 516-735-3550
  • Fax: 516-735-8067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number053543
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: