Provider Demographics
NPI:1396790952
Name:DR CUTUGNO ONCOLOGY AND HEMATOLOGY SPECIALIST PLLC
Entity type:Organization
Organization Name:DR CUTUGNO ONCOLOGY AND HEMATOLOGY SPECIALIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTUGNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-340-2100
Mailing Address - Street 1:105 MARYS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5848
Mailing Address - Country:US
Mailing Address - Phone:845-340-2100
Mailing Address - Fax:845-340-0202
Practice Address - Street 1:105 MARYS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5848
Practice Address - Country:US
Practice Address - Phone:845-340-2100
Practice Address - Fax:845-340-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210263174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01856468Medicaid
NY01856468Medicaid
NYWHW181Medicare PIN