Healthcare Provider Details

I. General information

NPI: 1164300356
Provider Name (Legal Business Name): MR. BARRY STUART TUSSMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 DORIS PL
MASSAPEQUA NY
11758-4003
US

IV. Provider business mailing address

336 36TH ST
LINDENHURST NY
11757-2600
US

V. Phone/Fax

Practice location:
  • Phone: 631-320-4662
  • Fax:
Mailing address:
  • Phone: 917-742-6292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number267021
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: