Provider Demographics
NPI:1801350608
Name:JUNGSIL K CUSIMANO MD, INC.
Entity type:Organization
Organization Name:JUNGSIL K CUSIMANO MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNGSIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:CUSIMANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-206-2007
Mailing Address - Street 1:3608 BALLASTONE DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-8069
Mailing Address - Country:US
Mailing Address - Phone:607-206-2007
Mailing Address - Fax:
Practice Address - Street 1:18842 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4978
Practice Address - Country:US
Practice Address - Phone:813-536-2542
Practice Address - Fax:813-536-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty