Healthcare Provider Details

I. General information

NPI: 1427772052
Provider Name (Legal Business Name): JOHN ANTHONY CUOMO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 E SUFFOLK AVE
CENTRAL ISLIP NY
11722-2340
US

IV. Provider business mailing address

442 CHELSEA AVE
WEST BABYLON NY
11704-4030
US

V. Phone/Fax

Practice location:
  • Phone: 631-234-6760
  • Fax:
Mailing address:
  • Phone: 631-627-5474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number069181
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: