1780664821 NPI number — JAMES MARIANO FUSARO M.D.

Table of content: JAMES MARIANO FUSARO M.D. (NPI 1780664821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780664821 NPI number — JAMES MARIANO FUSARO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FUSARO
Provider First Name:
JAMES
Provider Middle Name:
MARIANO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780664821
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1706 CORLIES AVE
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
NEPTUNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07753-4908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-774-8900
Provider Business Mailing Address Fax Number:
732-988-4619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1706 CORLIES AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
NEPTUNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07753-4908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-774-8900
Provider Business Practice Location Address Fax Number:
732-988-4619
Provider Enumeration Date:
01/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MA042987 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: JF0388H10 . This is a "EMPIRE WELLCHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2K2123 . This is a "HEALTH NET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3327604 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4093761 . This is a "AETNA ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: MS081 . This is a "OXFORD ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: T3625 . This is a "NJ MANUFACTURER WKMNS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: UNITED HEALTHCARE . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0198878 . This is a "GHI ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com