Provider Demographics
NPI:1609590918
Name:CUPO, MARIA DAWN (AG-ACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:DAWN
Last Name:CUPO
Suffix:
Gender:F
Credentials:AG-ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 BUTTONWOOD PL
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-2109
Mailing Address - Country:US
Mailing Address - Phone:347-596-7114
Mailing Address - Fax:
Practice Address - Street 1:34 BUTTONWOOD PL
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-2109
Practice Address - Country:US
Practice Address - Phone:347-596-7114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY676148163W00000X
NY432504363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty