Healthcare Provider Details

I. General information

NPI: 1518046465
Provider Name (Legal Business Name): MICHAEL G. JUSINSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 08/28/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 DELAWARE AVE.
PALMERTON PA
18071-1518
US

IV. Provider business mailing address

614 DELAWARE AVE
PALMERTON PA
18071
US

V. Phone/Fax

Practice location:
  • Phone: 484-822-5320
  • Fax: 484-822-5321
Mailing address:
  • Phone: 484-822-5320
  • Fax: 484-822-8321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD429684
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: