Healthcare Provider Details

I. General information

NPI: 1467149906
Provider Name (Legal Business Name): ARLENE ALLISON CUDJOE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GARDEN CITY PLZ STE 100
GARDEN CITY NY
11530-3337
US

IV. Provider business mailing address

PO BOX 310
PLAINVIEW NY
11803-0310
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-6400
  • Fax: 516-307-8840
Mailing address:
  • Phone: 516-663-6400
  • Fax: 516-307-8840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number349362
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: