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General NPI Number Information
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NPI Number | 1437029618
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Entity Type | Individual
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Provider Name | DOMINIC CUSATO
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Gender | Male
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Dates
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Enumeration Date | 11/11/2025
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 225 E CITY AVE STE 10
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1724
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Country | US
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Telephone | 215-503-3838
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Fax |
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Provider Business Mailing Address
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Address Line | 1304 S 36TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19146-3204
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Country | US
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Telephone | 856-759-9384
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | SP28425
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License Number State | PA
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