Provider Demographics
NPI:1235885260
Name:POMARICO, EIKO FUKUDA (RN)
Entity Type:Individual
Prefix:
First Name:EIKO
Middle Name:FUKUDA
Last Name:POMARICO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19560A PECK AVE APT 3C
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2817
Mailing Address - Country:US
Mailing Address - Phone:516-301-7993
Mailing Address - Fax:
Practice Address - Street 1:19560A PECK AVE APT 3C
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2817
Practice Address - Country:US
Practice Address - Phone:516-301-7993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY654506-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse