Healthcare Provider Details

I. General information

NPI: 1871794271
Provider Name (Legal Business Name): ELIZABETH C CUSANO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CHAPEL ST
NEW HAVEN CT
06511-4405
US

IV. Provider business mailing address

300 GEORGE ST FL 6
NEW HAVEN CT
06511-6624
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-4044
  • Fax: 203-867-5287
Mailing address:
  • Phone: 203-785-6610
  • Fax: 203-785-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number001291
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: