Provider Demographics
NPI:1215920137
Name:CUSUMANO, LEO (MD)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:
Last Name:CUSUMANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2736
Mailing Address - Country:US
Mailing Address - Phone:716-701-6879
Mailing Address - Fax:716-806-1287
Practice Address - Street 1:132 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-1317
Practice Address - Country:US
Practice Address - Phone:716-375-7500
Practice Address - Fax:716-701-6853
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182357208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000527072008OtherBLUE CROSS
NY01207309Medicaid
E62722Medicare UPIN