Provider Demographics
NPI:1992734693
Name:GUSMANO, FLAVIA (MD)
Entity type:Individual
Prefix:DR
First Name:FLAVIA
Middle Name:
Last Name:GUSMANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1309
Mailing Address - Country:US
Mailing Address - Phone:718-423-7788
Mailing Address - Fax:718-229-2222
Practice Address - Street 1:212 RIDGE RD
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11363-1309
Practice Address - Country:US
Practice Address - Phone:718-423-7788
Practice Address - Fax:718-229-2222
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234942208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7172632OtherAETNA
NYP010234942OtherBLUE CHOICE
NYP020234942OtherBLUE CROSS BLUE SHIELD
NY02648864Medicaid
NY161881FLOtherPREFERRED CARE
NY7172632OtherAETNA
NYIA0824Medicare ID - Type Unspecified