Provider Demographics
NPI:1225236367
Name:THOMAS J CUOMO JR MD PC
Entity Type:Organization
Organization Name:THOMAS J CUOMO JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:CUOMO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:602-859-9888
Mailing Address - Street 1:13835 N TATUM BLVD # 9468
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5581
Mailing Address - Country:US
Mailing Address - Phone:602-859-9888
Mailing Address - Fax:480-922-5903
Practice Address - Street 1:13835 N TATUM BLVD # 9468
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5581
Practice Address - Country:US
Practice Address - Phone:602-859-9888
Practice Address - Fax:480-922-5903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21499207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZB20052Medicare UPIN
AZZ69454Medicare PIN