Healthcare Provider Details

I. General information

NPI: 1205124864
Provider Name (Legal Business Name): PATRICIA ANN DIFUSCO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA ANN DI FUSCO FNP

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 CHURCH AVE
BROOKLYN NY
11218-3718
US

IV. Provider business mailing address

65 CHURCH AVE
BROOKLYN NY
11218-3718
US

V. Phone/Fax

Practice location:
  • Phone: 718-819-6144
  • Fax: 718-819-6145
Mailing address:
  • Phone: 718-819-6144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number336930
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: