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General NPI Number Information
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NPI Number | 1417506361
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Entity Type | Individual
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Provider Name | MICHAEL ANTHONY FUSCO PA
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Gender | Male
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Dates
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Enumeration Date | 09/04/2019
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 6118 188TH ST
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-2713
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Country | US
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Telephone | 718-489-5003
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Fax | 631-350-0586
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Provider Business Mailing Address
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Address Line | 6118 188TH ST
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-2713
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Country | US
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Telephone | 718-489-5003
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Fax | 631-350-0586
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110-008610
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 024650
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License Number State | NY
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