Healthcare Provider Details

I. General information

NPI: 1891065223
Provider Name (Legal Business Name): RAY ANTHONY CUPID FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2012
Last Update Date: 01/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WEIRFIELD ST
BROOKLYN NY
11221-5120
US

IV. Provider business mailing address

105 WEIRFIELD ST
BROOKLYN NY
11221-5120
US

V. Phone/Fax

Practice location:
  • Phone: 347-413-6806
  • Fax:
Mailing address:
  • Phone: 347-413-6806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024169792
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF336876
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: