Provider Demographics
NPI:1730253840
Name:CUSCUNA, BERNICE (MS PT)
Entity type:Individual
Prefix:MS
First Name:BERNICE
Middle Name:
Last Name:CUSCUNA
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MANSION AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3524
Mailing Address - Country:US
Mailing Address - Phone:718-568-4148
Mailing Address - Fax:
Practice Address - Street 1:400 ROUTE 130
Practice Address - Street 2:ZAFFERESE PT
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2792
Practice Address - Country:US
Practice Address - Phone:609-918-0600
Practice Address - Fax:609-918-0601
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0211641225100000X
NJ40QA00868300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
QQ01810Medicare ID - Type Unspecified