MEDICARE: DONNA M CUGINI NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	302251	NY
2	363LG0600X	Gerontology Nurse Practitioner	340375-1	NY

General Provider Information

NPI Number	:	1639247042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA M CUGINI NP

Provider Business Mailing Address
First Line	:	1324 FOREST AVE STE 157
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-2044
Country	:	US
Telephone Number	:	917-796-9347
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 VANDERBILT AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-2604
Country	:	US
Telephone Number	:	718-447-0701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	03/02/2022

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