Healthcare Provider Details

I. General information

NPI: 1750795738
Provider Name (Legal Business Name): NICHOLAS J FUSELLA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 RIVER RD STE 301
SCHENECTADY NY
12309-1136
US

IV. Provider business mailing address

711 TROY SCHENECTADY RD STE 203
LATHAM NY
12110-2461
US

V. Phone/Fax

Practice location:
  • Phone: 518-280-8470
  • Fax: 518-280-8471
Mailing address:
  • Phone: 518-782-3700
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number289391
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: