Provider Demographics
NPI:1225068216
Name:CUSSATTI, EDWARD HUGO (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:HUGO
Last Name:CUSSATTI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:786 MONTAUK HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-0070
Mailing Address - Country:US
Mailing Address - Phone:631-587-5800
Mailing Address - Fax:631-669-0222
Practice Address - Street 1:786 MONTAUK HIGHWAY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-0070
Practice Address - Country:US
Practice Address - Phone:631-587-5800
Practice Address - Fax:631-669-0222
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2013-08-07
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Provider Licenses
StateLicense IDTaxonomies
NY2278601208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3900590OtherCIGNA
NY2314404OtherUNITED HEALTH CARE
NY131109POtherHIP
NY3C5898OtherHEALTHNET
NY76V111OtherBLUE CROSS
NY151007OtherVYTRA
NYP2956224OtherOXFORD FREEDOM
NY3C5898OtherHEALTHNET
NY3900590OtherCIGNA
NYP2956224OtherOXFORD FREEDOM