Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | F421100-1 | NY |
NPI | 1003257320 |
---|---|
Provider Name | Ms. Maryellen Cucuzzo |
First Address | Holbrook, NY 11741-3024 |
Second Address | Brentwood, NY 11717-4311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2013 |
Last Update Date | 15/07/2013 |