Healthcare Provider Details

I. General information

NPI: 1275114019
Provider Name (Legal Business Name): MICHELE CUPID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 EDWARD L GRANT HWY
BRONX NY
10452-3112
US

IV. Provider business mailing address

3321 BAYCHESTER AVE
BRONX NY
10469-2621
US

V. Phone/Fax

Practice location:
  • Phone: 917-737-8555
  • Fax:
Mailing address:
  • Phone: 646-633-8058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: