1487854873 NPI number — MRS. EVELYN TERESA CUOMO R.N.

Table of content: MRS. EVELYN TERESA CUOMO R.N. (NPI 1487854873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487854873 NPI number — MRS. EVELYN TERESA CUOMO R.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUOMO
Provider First Name:
EVELYN
Provider Middle Name:
TERESA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.N.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FITZSIMMONS
Provider Other First Name:
EVELYN
Provider Other Middle Name:
TERESA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.N.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487854873
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
181 W MAIN ST
Provider Second Line Business Mailing Address:
AMHC OFFICE
Provider Business Mailing Address City Name:
BABYLON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11702-3435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-422-2300
Provider Business Mailing Address Fax Number:
631-360-3982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 W MAIN ST
Provider Second Line Business Practice Location Address:
AMHC OFFICE
Provider Business Practice Location Address City Name:
BABYLON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11702-3435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-422-2300
Provider Business Practice Location Address Fax Number:
631-360-3982
Provider Enumeration Date:
07/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  3081291 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 302F00000X , with the licence number: 308129-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)