Provider Demographics
NPI:1427772052
Name:CUOMO, JOHN ANTHONY
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:CUOMO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 CHELSEA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-4030
Mailing Address - Country:US
Mailing Address - Phone:631-627-5474
Mailing Address - Fax:
Practice Address - Street 1:2 E SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-2340
Practice Address - Country:US
Practice Address - Phone:631-234-6760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist