Healthcare Provider Details

I. General information

NPI: 1558710707
Provider Name (Legal Business Name): CRISTEN MARILYN CUSUMANO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 FROM RD STE 170
PARAMUS NJ
07652-3517
US

IV. Provider business mailing address

660 WHITE PLAINS RD STE 400
TARRYTOWN NY
10591-5107
US

V. Phone/Fax

Practice location:
  • Phone: 201-722-9850
  • Fax: 201-722-9851
Mailing address:
  • Phone: 914-333-5801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25MA11108300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: