Healthcare Provider Details

I. General information

NPI: 1477370450
Provider Name (Legal Business Name): EMILY CUOMO L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 INDIAN HEAD RD
KINGS PARK NY
11754-4810
US

IV. Provider business mailing address

52 BAYVIEW AVE APT 1A
NORTHPORT NY
11768-1506
US

V. Phone/Fax

Practice location:
  • Phone: 631-813-8600
  • Fax:
Mailing address:
  • Phone: 631-275-9747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007571
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: