MEDICARE: DR. ANTHONY M CUOMO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	5112	CT
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	30972	NY

General Provider Information

NPI Number	:	1720012578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY M CUOMO DDS

Provider Business Mailing Address
First Line	:	667 STONELEIGH AVE
Second Line	:	SUITE 301
City	:	CARMEL
State	:	NY
Zip	:	10512-2454
Country	:	US
Telephone Number	:	845-278-2101
Fax Number	:	845-278-8806

Provider Business Practice Location Address
First Line	:	667 STONELEIGH AVE
Second Line	:	SUITE 301
City	:	CARMEL
State	:	NY
Zip	:	10512-2454
Country	:	US
Telephone Number	:	845-278-2101
Fax Number	:	845-278-8806

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/08/2007

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