MEDICARE: DR. VINCENT PAT FUSCHINO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	50056046	NY

General Provider Information

NPI Number	:	1164719316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT PAT FUSCHINO DDS

Provider Business Mailing Address
First Line	:	42 N MAIN ST
Second Line	:
City	:	MECHANICVILLE
State	:	NY
Zip	:	12118-1908
Country	:	US
Telephone Number	:	518-664-2411
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 N MAIN ST
Second Line	:
City	:	MECHANICVILLE
State	:	NY
Zip	:	12118-1908
Country	:	US
Telephone Number	:	518-664-2411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2011
Last Update Date	:	07/13/2012

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