Healthcare Provider Details

I. General information

NPI: 1316212657
Provider Name (Legal Business Name): MS. BARBARA ANN CUSUMANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BARBARA ANN CUSUMANO RN

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 HARING ST
BROOKLYN NY
11235-1655
US

IV. Provider business mailing address

4 MEYER AVE
LAWRENCE NY
11559-1006
US

V. Phone/Fax

Practice location:
  • Phone: 718-769-3498
  • Fax: 718-648-7816
Mailing address:
  • Phone: 718-769-3498
  • Fax: 718-648-7816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number338594
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: