Healthcare Provider Details

I. General information

NPI: 1861935249
Provider Name (Legal Business Name): ANN-MARIE CUCINOTTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2016
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2966 137TH ST
FLUSHING NY
11354-2044
US

IV. Provider business mailing address

2966 137TH ST
FLUSHING NY
11354-2044
US

V. Phone/Fax

Practice location:
  • Phone: 718-445-2902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number017332
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: