MEDICARE: JEANETTE E CUEVA MD

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	103TP0016X	Prescribing (Medical) Psychologist	180828	NY

General Provider Information

NPI Number	:	1689898983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE E CUEVA MD

Provider Business Mailing Address
First Line	:	40 PARK AVE
Second Line	:	SUITE 1K
City	:	NEW YORK
State	:	NY
Zip	:	10016-3467
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 PARK AVE APT 1K
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-3456
Country	:	US
Telephone Number	:	212-685-5373
Fax Number	:	212-726-0034

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/11/2007

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