Provider Demographics
NPI:1780616383
Name:KUUSISTO, CAROL LIISA (DO)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LIISA
Last Name:KUUSISTO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 5TH AVE
Mailing Address - Street 2:APT. 2A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4319
Mailing Address - Country:US
Mailing Address - Phone:212-533-6986
Mailing Address - Fax:212-627-3770
Practice Address - Street 1:87 5TH AVE # 89
Practice Address - Street 2:SUITE 604
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3020
Practice Address - Country:US
Practice Address - Phone:212-675-9343
Practice Address - Fax:212-627-3770
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232095208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation