=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750592853
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERARD JAMES FUSARO D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2007
-----------------------------------------------------
Last Update Date | 01/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 E 48TH ST # 1B
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017-1509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-410-3640
-----------------------------------------------------
Fax | 212-288-2713
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 48 LEONARD DR
-----------------------------------------------------
City | MASSAPEQUA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11758-7920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-410-3640
-----------------------------------------------------
Fax | 212-208-4648
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | X033339
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------