Healthcare Provider Details

I. General information

NPI: 1225746597
Provider Name (Legal Business Name): BYRON GERARD FUSELIER JR. FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 FORT WASHINGTON AVE
NEW YORK NY
10032-3739
US

IV. Provider business mailing address

173 FORT WASHINGTON AVE
NEW YORK NY
10032-3739
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-4600
  • Fax: 212-305-7439
Mailing address:
  • Phone: 212-305-4600
  • Fax: 212-305-7439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number350729
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: