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General NPI Number Information
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NPI Number | 1619254513
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Entity Type | Individual
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Provider Name | JEREMY K CUSANO P.T.
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Gender | Male
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Dates
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Enumeration Date | 11/07/2011
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Last Update Date | 11/07/2011
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Provider Practice Location Address
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Address Line | 2351 JERUSALEM AVE
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City | NORTH BELLMORE
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State | NY
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Zip | 11710-1822
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Country | US
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Telephone | 516-608-6339
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Fax |
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Provider Business Mailing Address
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Address Line | 88A GRAND BLVD
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-2531
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Country | US
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Telephone | 516-698-6354
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 019463
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License Number State | NY
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