Provider Demographics
NPI:1619017910
Name:CUSA, GERARD J (MD)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:J
Last Name:CUSA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:400 S OYSTER BAY RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3500
Mailing Address - Country:US
Mailing Address - Phone:516-939-0164
Mailing Address - Fax:516-939-0165
Practice Address - Street 1:400 S OYSTER BAY RD
Practice Address - Street 2:SUITE 302
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3500
Practice Address - Country:US
Practice Address - Phone:516-939-0164
Practice Address - Fax:516-939-0165
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2015-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY156842207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA65081Medicare UPIN