MEDICARE: VINCENT FUSCHINO, DDS, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	056046	NY

General Provider Information

NPI Number	:	1225404833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINCENT FUSCHINO, DDS, P.C.

Provider Business Mailing Address
First Line	:	42 N MAIN ST
Second Line	:
City	:	MECHANICVILLE
State	:	NY
Zip	:	12118-1908
Country	:	US
Telephone Number	:	518-664-4903
Fax Number	:	518-664-2411

Provider Business Practice Location Address
First Line	:	42 N MAIN ST
Second Line	:
City	:	MECHANICVILLE
State	:	NY
Zip	:	12118-1908
Country	:	US
Telephone Number	:	518-664-4903
Fax Number	:	518-664-2411

Authorized Official
Title or Position	:	C.E.O.
Name	:	DR. VINCENT PAT FUSCHINO
Credential	:	D.D.S.
Telephone Number	:	518-664-4903

Provider Enumeration Date	:	08/18/2015
Last Update Date	:	08/18/2015

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