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General NPI Number Information
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NPI Number | 1003257320
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Entity Type | Individual
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Provider Name | MARYELLEN CUCUZZO NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 600 SUFFOLK AVE STE C
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City | BRENTWOOD
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State | NY
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Zip | 11717-4311
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Country | US
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Telephone | 631-273-3712
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Fax | 631-273-3745
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Provider Business Mailing Address
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Address Line | 123 SINGINGWOOD DR
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City | HOLBROOK
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State | NY
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Zip | 11741-3024
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Country | US
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Telephone | 631-472-4435
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Fax | 631-472-4435
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | F421100-1
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License Number State | NY
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