Provider Demographics
NPI:1184747057
Name:CUGNO, MARY ALICE
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ALICE
Last Name:CUGNO
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 1:42 HASECO AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-3925
Mailing Address - Country:US
Mailing Address - Phone:914-934-2475
Mailing Address - Fax:
Practice Address - Street 1:162 JOURNEYS END RD
Practice Address - Street 2:
Practice Address - City:SOUTH SALEM
Practice Address - State:NY
Practice Address - Zip Code:10590-2529
Practice Address - Country:US
Practice Address - Phone:914-763-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00085281164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01543562Medicaid