Healthcare Provider Details

I. General information

NPI: 1982802435
Provider Name (Legal Business Name): LEO CUSUMANO, M.D. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 WATER ST
CUBA NY
14727-1023
US

IV. Provider business mailing address

38 WATER ST
CUBA NY
14727-1023
US

V. Phone/Fax

Practice location:
  • Phone: 585-968-4137
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LEO CUSUMANO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 585-968-4137