Healthcare Provider Details

I. General information

NPI: 1184747057
Provider Name (Legal Business Name): MRS. MARY ALICE CUGNO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 JOURNEYS END RD
SOUTH SALEM NY
10590-2529
US

IV. Provider business mailing address

42 HASECO AVE
PORT CHESTER NY
10573-3925
US

V. Phone/Fax

Practice location:
  • Phone: 914-763-0341
  • Fax:
Mailing address:
  • Phone: 914-934-2475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number00085281
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: