Provider Demographics
NPI:1245210145
Name:T. ANTHONY CUMBO MD PLLC
Entity Type:Organization
Organization Name:T. ANTHONY CUMBO MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-575-4157
Mailing Address - Street 1:793 CENTER ST.
Mailing Address - Street 2:#482
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092
Mailing Address - Country:US
Mailing Address - Phone:866-575-4157
Mailing Address - Fax:
Practice Address - Street 1:1150 YOUNGS RD
Practice Address - Street 2:#210
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092
Practice Address - Country:US
Practice Address - Phone:866-575-4157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226644207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000528277001OtherBLUE CROSS / BLUE SHIELD
NY3413004OtherINDEPENDANT HEALTH
NY02664579Medicaid
NY02664579Medicaid