Provider Demographics
NPI:1225391451
Name:RAMOS-CUTOLO, JEANNETTE
Entity Type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:
Last Name:RAMOS-CUTOLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 KLOTHE DR
Mailing Address - Street 2:
Mailing Address - City:GRAHAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12740-5805
Mailing Address - Country:US
Mailing Address - Phone:845-985-7080
Mailing Address - Fax:845-985-7070
Practice Address - Street 1:101 KLOTHE DR
Practice Address - Street 2:
Practice Address - City:GRAHAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12740-5805
Practice Address - Country:US
Practice Address - Phone:845-985-7080
Practice Address - Fax:845-985-7070
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY738895082171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY738895082OtherDRIVERS LICENSE