Healthcare Provider Details

I. General information

NPI: 1992974679
Provider Name (Legal Business Name): EDWARD GUSICK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 ROOSEVELT AVE STE 12000
SELINSGROVE PA
17870-7998
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 570-524-4446
  • Fax: 570-768-4623
Mailing address:
  • Phone: 717-851-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberOS016038
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: