Healthcare Provider Details

I. General information

NPI: 1417138587
Provider Name (Legal Business Name): MS. MIRJANA CUPI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 HILLSIDE AVE
NEW HYDE PARK NY
11040-2512
US

IV. Provider business mailing address

26518 83RD AVE
FLORAL PARK NY
11004-1731
US

V. Phone/Fax

Practice location:
  • Phone: 516-328-3434
  • Fax: 516-328-6371
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number037388
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: