MEDICARE: FRANK FUSCALDO

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	22DI01858200	NJ

General Provider Information

NPI Number	:	1578783569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANK FUSCALDO

Provider Business Mailing Address
First Line	:	PO BOX 1326
Second Line	:	4301 NEW JERSEY AVE
City	:	WILDWOOD
State	:	NJ
Zip	:	08260-8326
Country	:	US
Telephone Number	:	609-522-1471
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 NEW JERSEY AVE
Second Line	:
City	:	WILDWOOD
State	:	NJ
Zip	:	08260-1824
Country	:	US
Telephone Number	:	609-522-1471
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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Directions to “ FRANK FUSCALDO ” Practice Location

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