Provider Demographics
NPI:1326228123
Name:CUTUGNO, GRACE ALISON (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:ALISON
Last Name:CUTUGNO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MS
Other - First Name:GRACE
Other - Middle Name:ALISON
Other - Last Name:LASELVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:9921 4TH AVE
Mailing Address - Street 2:BAY RIDGE SKIN AND CANCER DERMATOLOGY P.C.
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-8347
Mailing Address - Country:US
Mailing Address - Phone:718-833-7616
Mailing Address - Fax:718-680-4297
Practice Address - Street 1:9921 4TH AVE
Practice Address - Street 2:BAY RIDGE SKIN AND CANCER DERMATOLOGY P.C.
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-8347
Practice Address - Country:US
Practice Address - Phone:718-833-7616
Practice Address - Fax:718-680-4297
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012079363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant