Healthcare Provider Details

I. General information

NPI: 1245868272
Provider Name (Legal Business Name): BRENDON MICHAEL FUSCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 NOSTRAND AVE
BROOKLYN NY
11210-3037
US

IV. Provider business mailing address

2236 NOSTRAND AVE
BROOKLYN NY
11210-3037
US

V. Phone/Fax

Practice location:
  • Phone: 718-406-9454
  • Fax:
Mailing address:
  • Phone: 718-406-9454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number324747
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: