Provider Demographics
NPI:1477555761
Name:CUTUGNO, ALFONSO (MD)
Entity type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:
Last Name:CUTUGNO
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:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:WEST PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12493-0195
Mailing Address - Country:US
Mailing Address - Phone:845-706-7062
Mailing Address - Fax:
Practice Address - Street 1:6511 SPRING BROOK AVE STE 101
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-3709
Practice Address - Country:US
Practice Address - Phone:845-871-3545
Practice Address - Fax:845-871-3546
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210263207RH0003X
NHEL11277207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01856468Medicaid
NY6T6501Medicare ID - Type Unspecified
NYG68993Medicare UPIN