Healthcare Provider Details

I. General information

NPI: 1336574540
Provider Name (Legal Business Name): SUSAN CUOCCIO MS.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 MAPLE AVE
FLORAL PARK NY
11001-2512
US

IV. Provider business mailing address

56 MAPLE AVE
FLORAL PARK NY
11001-2512
US

V. Phone/Fax

Practice location:
  • Phone: 516-326-2004
  • Fax:
Mailing address:
  • Phone: 516-326-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number978127001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: