Provider Demographics
NPI:1396807830
Name:CUPELLI, EMILY TOMASINO (NP)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:TOMASINO
Last Name:CUPELLI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 JAYSON AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4238
Mailing Address - Country:US
Mailing Address - Phone:516-773-3087
Mailing Address - Fax:
Practice Address - Street 1:56 JAYSON AVE
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4238
Practice Address - Country:US
Practice Address - Phone:516-773-3087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY380652363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS92788Medicare UPIN