Provider Demographics
NPI:1558710707
Name:CUSUMANO, CRISTEN MARILYN (MD)
Entity Type:Individual
Prefix:
First Name:CRISTEN
Middle Name:MARILYN
Last Name:CUSUMANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 WHITE PLAINS RD STE 400
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5107
Mailing Address - Country:US
Mailing Address - Phone:914-333-5801
Mailing Address - Fax:
Practice Address - Street 1:650 FROM RD STE 170
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3517
Practice Address - Country:US
Practice Address - Phone:201-722-9850
Practice Address - Fax:201-722-9851
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11108300207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology