Provider Demographics
NPI:1770007767
Name:COTRONEO, GRACEANN
Entity type:Individual
Prefix:
First Name:GRACEANN
Middle Name:
Last Name:COTRONEO
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 1:61 PLUMTREE LN FL 1
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1508
Mailing Address - Country:US
Mailing Address - Phone:347-598-0223
Mailing Address - Fax:
Practice Address - Street 1:61 PLUMTREE LANE
Practice Address - Street 2:1ST FL
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309
Practice Address - Country:US
Practice Address - Phone:347-598-0223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY721985131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist