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General NPI Number Information
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NPI Number | 1801350608
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Entity Type | Organization
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Legal Business Name | JUNGSIL K CUSIMANO MD, INC.
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 01/25/2019
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Provider Practice Location Address
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Address Line | 18842 N DALE MABRY HWY
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City | LUTZ
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State | FL
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Zip | 33548-4978
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Country | US
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Telephone | 813-536-2542
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Fax | 813-536-2544
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Provider Business Mailing Address
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Address Line | 3608 BALLASTONE DR
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City | LAND O LAKES
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State | FL
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Zip | 34638-8069
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Country | US
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Telephone | 607-206-2007
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUNGSIL K CUSIMANO
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Credential | MD
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Telephone | 607-206-2007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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