Basic Information
| Provider Information | |||||||||
| NPI: | 1144283417 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUCUZZELLA | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | ROWE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4735 OGLETOWN-STANTON RD | ||||||||
| Address2: | SUITE 3302 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026234144 | ||||||||
| FaxNumber: | 3026234147 | ||||||||
| Practice Location | |||||||||
| Address1: | 4735 OGLETOWN-STANTON RD | ||||||||
| Address2: | SUITE 3302 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026234144 | ||||||||
| FaxNumber: | 3026234147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2006 | ||||||||
| LastUpdateDate: | 07/07/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | CI0004249 | DE | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 0801265000 | 01 | DE | AMERIHEALTH | OTHER | 4650027 | 01 | DE | AETNA | OTHER | 2114922 | 01 | DE | UNITED HEALTH CARE | OTHER | 510110596 | 01 | DE | BCBS OF DE | OTHER | 2044A | 01 | DE | COVENTRY | OTHER |