Most Relevant Information
Provider Data
| NPI Number: | 1003257320 |
| Provider Name: | MARYELLEN CUCUZZO NURSE PRACTITIONER |
| Entity Type: | Individual |
| Taxonomy Code: | 363LW0102X |
| Specialty: | Nurse Practitioner |
| License Number: | F421100-1 |
Most Important Dates
| Enumeration Date: | 07/15/2013 |
| Last Updated: | 07/15/2013 |
Provider Practice Location
600 SUFFOLK AVE STE C
BRENTWOOD
NY
117174311
Practice Location Phone/Fax
| Phone: | 6312733712 |
| Fax: | 6312733745 |
Provider Mailing Location
123 SINGINGWOOD DR
HOLBROOK
NY
117413024
Provider Mailing Phone/Fax
| Phone: | 6314724435 |
| Fax: | 6314724435 |