Provider Demographics
NPI:1669514824
Name:CUTAIA, CONCETTA MARIA
Entity type:Individual
Prefix:MS
First Name:CONCETTA
Middle Name:MARIA
Last Name:CUTAIA
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 1:7 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14470-1115
Mailing Address - Country:US
Mailing Address - Phone:585-638-5789
Mailing Address - Fax:
Practice Address - Street 1:7 WEST AVE
Practice Address - Street 2:
Practice Address - City:HOLLEY
Practice Address - State:NY
Practice Address - Zip Code:14470-1115
Practice Address - Country:US
Practice Address - Phone:585-638-5789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274457-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02549264Medicaid
NY274457-1OtherNURSING LICENSE NUMBER