Healthcare Provider Details

I. General information

NPI: 1457447195
Provider Name (Legal Business Name): ROBERT JOSEPH CUSUMANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 KINDERKAMACK ROAD SUITE 101
ORADELL NJ
07649
US

IV. Provider business mailing address

660 WHITE PLAINS RD FL 4
TARRYTOWN NY
10591-5139
US

V. Phone/Fax

Practice location:
  • Phone: 201-722-9850
  • Fax: 201-722-9851
Mailing address:
  • Phone: 914-984-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25MA05034500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: