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General NPI Number Information
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NPI Number | 1609166776
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Entity Type | Individual
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Provider Name | KUSUMA NIO M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 11/15/2019
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Provider Practice Location Address
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Address Line | 1111 AMSTERDAM AVE
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City | NEW YORK
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State | NY
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Zip | 10025
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Country | US
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Telephone | 212-523-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 AMSTERDAM AVE
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City | NEW YORK
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State | NY
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Zip | 10025-1716
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Country | US
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Telephone |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036-140884
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | 268076-01
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License Number State | NY
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