Individual
CAROL CUPOLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
760 BROADWAY, 6B23, BROOKLYN, NY 11206-5317
(718) 963-7956
Mailing address
208 EDWARD CT, WEST HEMPSTEAD, NY 11552-2308
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002676
NY
Other
Enumeration date
03/10/2015
Last updated
03/11/2015
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