Healthcare Provider Details

I. General information

NPI: 1104119510
Provider Name (Legal Business Name): ARELIS CUEVAS MSOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CHRISTOPHER CT
MIDDLETOWN NY
10941-2054
US

IV. Provider business mailing address

11 CHRISTOPHER CT
MIDDLETOWN NY
10941-2054
US

V. Phone/Fax

Practice location:
  • Phone: 917-696-2036
  • Fax:
Mailing address:
  • Phone: 917-696-2036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number014475-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: