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General NPI Number Information
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NPI Number | 1104176312
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Entity Type | Organization
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Legal Business Name | GERARD J. CUSA M.D., PLLC
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 400 S OYSTER BAY RD SUITE 302
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City | HICKSVILLE
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State | NY
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Zip | 11801-3500
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Country | US
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Telephone | 516-939-0164
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Fax | 516-939-0165
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Provider Business Mailing Address
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Address Line | 400 S OYSTER BAY RD SUITE 302
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City | HICKSVILLE
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State | NY
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Zip | 11801-3500
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Country | US
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Telephone | 516-939-0164
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Fax | 516-939-0165
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Authorized Official
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Title or Position | OWNER
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Name | DR. GERARD J. CUSA
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Credential | M.D.
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Telephone | 516-939-0164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 156842
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License Number State | NY
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