Provider Demographics
NPI:1588936603
Name:CUETO, ELISA (PERMANENT LICENCE)
Entity type:Individual
Prefix:MS
First Name:ELISA
Middle Name:
Last Name:CUETO
Suffix:
Gender:F
Credentials:PERMANENT LICENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6305 252ND ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2305
Mailing Address - Country:US
Mailing Address - Phone:516-406-6654
Mailing Address - Fax:
Practice Address - Street 1:6305 252ND ST
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-2305
Practice Address - Country:US
Practice Address - Phone:516-406-6654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-05
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246541031174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist