Healthcare Provider Details

I. General information

NPI: 1568633147
Provider Name (Legal Business Name): MELISSA ANN CUSUMANO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 OLD COUNTRY RD
PLAINVIEW NY
11803-4914
US

IV. Provider business mailing address

352 ARCHER ST
FREEPORT NY
11520-4233
US

V. Phone/Fax

Practice location:
  • Phone: 516-719-0012
  • Fax:
Mailing address:
  • Phone: 516-770-6574
  • Fax: 516-771-9818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number240976
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: