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General NPI Number Information
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NPI Number | 1790779148
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Entity Type | Individual
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Provider Name | KENNETH T DEFUSCO MD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 10/04/2010
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Provider Practice Location Address
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Address Line | 2 W NORTHFIELD RD
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City | LIVINGSTON
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State | NJ
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Zip | 07039-3789
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Country | US
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Telephone | 973-994-1544
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Fax | 973-994-2387
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Provider Business Mailing Address
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Address Line | 2 W NORTHFIELD RD
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City | LIVINGSTON
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State | NJ
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Zip | 07039-3789
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Country | US
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Telephone | 973-994-1544
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Fax | 973-994-2387
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | MA23958
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License Number State | NJ
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