Healthcare Provider Details

I. General information

NPI: 1588974943
Provider Name (Legal Business Name): MICHAEL E FUSARO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 HINE ST SUITE 212
PATERSON NJ
07503-2955
US

IV. Provider business mailing address

32 HINE ST SUITE 212
PATERSON NJ
07503-2955
US

V. Phone/Fax

Practice location:
  • Phone: 973-742-9111
  • Fax: 973-742-9017
Mailing address:
  • Phone: 973-742-9111
  • Fax: 973-742-9017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL FUSARO
Title or Position: PRESIDENT
Credential: DPM
Phone: 973-742-9111