Healthcare Provider Details

I. General information

NPI: 1487716841
Provider Name (Legal Business Name): MR. ANTHONY CUOCO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 5TH AVE
BROOKLYN NY
11215-5436
US

IV. Provider business mailing address

582 5TH AVE
BROOKLYN NY
11215-5436
US

V. Phone/Fax

Practice location:
  • Phone: 718-499-2616
  • Fax: 718-499-0440
Mailing address:
  • Phone: 718-499-2616
  • Fax: 718-499-0440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number36876
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: