Healthcare Provider Details

I. General information

NPI: 1720012578
Provider Name (Legal Business Name): ANTHONY M CUOMO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 STONELEIGH AVE SUITE 301
CARMEL NY
10512-2454
US

IV. Provider business mailing address

667 STONELEIGH AVE SUITE 301
CARMEL NY
10512-2454
US

V. Phone/Fax

Practice location:
  • Phone: 845-278-2101
  • Fax: 845-278-8806
Mailing address:
  • Phone: 845-278-2101
  • Fax: 845-278-8806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5112
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30972
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: