JACLYN CUSUMANO (NPI# 1114565462) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114565462 |
| Entity Type | Individual |
| Full Name | JACLYN CUSUMANO |
| Credential | PHARMD |
| Practice Address |
2510 30th Ave Astoria NY 11102-2448 |
| Mailing Address |
75 Dekalb Ave Brooklyn NY 11201-5423 |
| Practice Telephone | 7189321000 |
| Mailing Telephone | 7184881246 |
| Enumeration Date | 2019-12-17 |
| Last Update Date | 2019-12-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1835P0018X |
Pharmacist Specialization: Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
708353 | NY | Pharmacy Service Providers |
| Street Address |
2510 30TH AVE |
| City | ASTORIA |
| State | NY |
| Zip Code | 11102-2448 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366042012 | Joshua Guevarra | Physician Assistant | 2510 30th Ave, Astoria, NY 11102-2418 | 2020-10-30 |
| 1003454117 | Kamilia Ait Belkacem | Physician Assistant | 2510 30th Ave, Astoria, NY 11102-2448 | 2019-12-19 |
| 1457999617 | Laura Mackey | Nurse Practitioner | 2510 30th Ave, Astoria, NY 11102-2448 | 2019-12-18 |
| 1104476738 | Gabriel Eugene Spencer | Physician Assistant | 2510 30th Ave, Astoria, NY 11102-2418 | 2019-09-16 |
| 1073162269 | Amy Xu | Physician Assistant | 2510 30th Ave, Astoria, NY 11102-2448 | 2019-09-10 |
| 1912551235 | Ashley Marie Chowdhury | Nurse Practitioner | 2510 30th Ave, Astoria, NY 11102-2448 | 2019-07-25 |
| 1457811630 | Yoohyun Kim | Physician Assistant | 2510 30th Ave, Astoria, NY 11102-2418 | 2019-03-22 |
| 1134691637 | Kerstin Connaire | Nurse Practitioner | 2510 30th Ave, Astoria, NY 11102-2448 | 2018-12-20 |
| 1508334111 | Trishanna Yankannah | Physician Assistant | 2510 30th Ave, Astoria, NY 11102-2448 | 2018-11-13 |
| 1770067043 | Julia Yusupova | Physician Assistant | 2510 30th Ave, Astoria, NY 11102-2448 | 2018-09-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497301444 | Stephanie Angela Van Rossem | Nurse Practitioner | 28-18 Astoria Blvd, Astoria, Ny 11102, Astoria, NY 11102 | 2019-08-15 |
| 1831754118 | Ahmed Mohamed Sayed Zedan | Pharmacist | 3014 14th St, Astoria, NY 11102 | 2019-05-02 |
| 1841758927 | Prohealth Care Associates, LLP | Occupational Therapist | 27-17 Cresecent Street, Suite 1, Astoria, NY 11102 | 2019-03-07 |
| 1598231292 | Mayuri Ardak | Student in an Organized Health Care Education/Training Program | 25-40 30th Road Suite A1, Astoria, NY 11102 | 2018-10-19 |
| 1134626740 | Claudia Ahumada, Lcsw, Pllc | Social Worker | 2556 31st St Ste 302, Astoria, NY 11102 | 2018-04-10 |
| 1255840039 | Ashley Taylor Curaba | Physician Assistant | 25-10 30th Rd, Queens, NY 11102 | 2017-09-25 |
| 1265953517 | Kathleen Yetman | Student in an Organized Health Care Education/Training Program | 2707 8th Street, The Astoria Blue Feather Profram, Astoria, NY 11102 | 2017-06-27 |
| 1679933998 | Tarek R Khater | Clinic/Center | 2814 31st St, Suite 501, Astoria, NY 11102 | 2016-02-29 |
| 1295194116 | Individualized Family Care LLC | Community/Behavioral Health | 12-22 30th Ave, Apt 4h, Astoria, NY 11102 | 2016-02-19 |
| 1700288909 | Andre Farah Dc PC | Chiropractor | 29-15 Astoria Blvd, Astoria, NY 11102 | 2014-09-18 |
| Find all providers in zip 11102 | ||||
| Taxonomy Code | 1835P0018X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| Specialization | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |
| Notes: Source: National Uniform Claim Committee, 2007 [1/1/2008: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609243641 | Debra Kumm | Pharmacist | 2120 Exchange St, Suite 101, Astoria, OR 97103-3365 | 2015-08-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285241794 | Erika Modh | Pharmacist | 6220 11th Ave, Brooklyn, NY 11219-5204 | 2020-09-29 |
| 1457990657 | Hina Khawaja | Pharmacist | 24 E 24th St, Huntington Station, NY 11746-3702 | 2020-01-06 |
| 1508411810 | Michael Richard Izzo | Pharmacist | 104 Reservoir Rd, Little Falls, NY 13365-5924 | 2019-08-04 |
| 1306498100 | Cerris Chung | Pharmacist | 320 E 94th St # 3f, New York, NY 10128-5604 | 2019-07-11 |
| 1558922419 | Jennifer Sophia Orozco | Pharmacist | 1275 York Ave # 710, New York, NY 10065-6007 | 2019-06-21 |
| 1558846014 | Lisa Chu | Pharmacist | 14634 23rd Ave, Whitestone, NY 11357-3514 | 2018-10-01 |
| 1841772514 | Salvatore Oreste | Pharmacist | 32 Alder Dr, Kings Park, NY 11754-2202 | 2018-08-30 |
| 1184138885 | B&t Port Richmond Pharmacy Inc. | Pharmacist | 251 Port Richmond Ave, Staten Island, NY 10302-1704 | 2017-11-17 |
| 1922510072 | Robert O'connell | Pharmacist | 3840 211th St Fl 2, Bayside, NY 11361-1956 | 2017-10-30 |
| 1427577048 | Fawzieh Mourtada | Pharmacist | Rite Aid, 540 West 235th Street, Bronx, NY 10643 | 2017-09-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.