Provider Demographics
NPI:1932144896
Name:CUTOLO, LOUIS C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:C
Last Name:CUTOLO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1557 VICTORY BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314
Mailing Address - Country:US
Mailing Address - Phone:718-720-9400
Mailing Address - Fax:718-665-1201
Practice Address - Street 1:1557 VICTORY BOULEVARD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314
Practice Address - Country:US
Practice Address - Phone:718-720-9400
Practice Address - Fax:718-556-1201
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY168307208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01557831Medicaid
NYF36435Medicare UPIN
NY82K231Medicare ID - Type Unspecified