Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 057290-1 | NY |
NPI | 1033407812 |
---|---|
Provider Name | Dr. Nicole Cuoccio |
First Address | East Northport, NY 11731-3427 |
Second Address | East Northport, NY 11731-3427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2011 |
Last Update Date | 25/08/2014 |