Provider Demographics
NPI:1972871366
Name:PAUL P CUSANO MD PA
Entity type:Organization
Organization Name:PAUL P CUSANO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:CUSANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-471-5256
Mailing Address - Street 1:925 CLIFTON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2724
Mailing Address - Country:US
Mailing Address - Phone:973-471-5256
Mailing Address - Fax:973-471-5157
Practice Address - Street 1:925 CLIFTON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2724
Practice Address - Country:US
Practice Address - Phone:973-471-5256
Practice Address - Fax:973-471-5157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA027638002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty