Healthcare Provider Details

I. General information

NPI: 1215920137
Provider Name (Legal Business Name): LEO CUSUMANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 W MAIN ST
CUBA NY
14727-1317
US

IV. Provider business mailing address

135 N UNION ST
OLEAN NY
14760-2736
US

V. Phone/Fax

Practice location:
  • Phone: 716-375-7500
  • Fax: 716-701-6853
Mailing address:
  • Phone: 716-701-6879
  • Fax: 716-806-1287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number182357
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: