Healthcare Provider Details

I. General information

NPI: 1598875148
Provider Name (Legal Business Name): JOSEPH M PRUSAKOWSKI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HOSPITAL RD SUITE 200
BROOKVILLE PA
15825-1382
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-849-1874
  • Fax: 814-849-1444
Mailing address:
  • Phone: 814-849-1874
  • Fax: 814-849-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS003498L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: