Provider Demographics
NPI:1477370450
Name:CUOMO, EMILY (LAC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:CUOMO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 BAYVIEW AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1506
Mailing Address - Country:US
Mailing Address - Phone:631-275-9747
Mailing Address - Fax:
Practice Address - Street 1:277 INDIAN HEAD RD
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-4810
Practice Address - Country:US
Practice Address - Phone:631-813-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007571171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist