Healthcare Provider Details

I. General information

NPI: 1750775912
Provider Name (Legal Business Name): JAMES CASSUTO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE
SUMMIT NJ
07901-3533
US

IV. Provider business mailing address

PO BOX 412826
BOSTON MA
02241-2526
US

V. Phone/Fax

Practice location:
  • Phone: 85-222-0659
  • Fax: 908-522-5763
Mailing address:
  • Phone: 610-892-8889
  • Fax: 484-446-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberS4927
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA11465600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: