Provider Demographics
NPI:1710955844
Name:CUSUMANO, THOMAS JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:CUSUMANO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26-06 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3829
Mailing Address - Country:US
Mailing Address - Phone:201-794-8200
Mailing Address - Fax:201-794-8201
Practice Address - Street 1:26-06 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3829
Practice Address - Country:US
Practice Address - Phone:201-794-8200
Practice Address - Fax:201-794-8201
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00002492213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8924007Medicaid
NJ156949OtherPTAN
NJ8924007Medicaid