Provider Demographics
NPI:1487854873
Name:CUOMO, EVELYN TERESA (RN)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:TERESA
Last Name:CUOMO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:EVELYN
Other - Middle Name:TERESA
Other - Last Name:FITZSIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:181 W MAIN ST
Mailing Address - Street 2:AMHC OFFICE
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3435
Mailing Address - Country:US
Mailing Address - Phone:631-422-2300
Mailing Address - Fax:631-360-3982
Practice Address - Street 1:181 W MAIN ST
Practice Address - Street 2:AMHC OFFICE
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3435
Practice Address - Country:US
Practice Address - Phone:631-422-2300
Practice Address - Fax:631-360-3982
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2008-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3081291163W00000X
NY308129-1302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No302F00000XManaged Care OrganizationsExclusive Provider Organization