Healthcare Provider Details

I. General information

NPI: 1710786421
Provider Name (Legal Business Name): ARIANNA B CUOCCO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 TECHNOLOGY DR
EAST SETAUKET NY
11733-4080
US

IV. Provider business mailing address

143 DAVIS AVE
PORT JEFFERSON STATION NY
11776-2025
US

V. Phone/Fax

Practice location:
  • Phone: 631-246-8289
  • Fax:
Mailing address:
  • Phone: 631-626-7116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number033514
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: