1790702678 NPI number — LOUIS D FUSILLI MD FACC

Table of content: LOUIS D FUSILLI MD FACC (NPI 1790702678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790702678 NPI number — LOUIS D FUSILLI MD FACC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FUSILLI
Provider First Name:
LOUIS
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD FACC
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:
1790702678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
181 FRANKLIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NUTLEY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07110-2900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-667-5511
Provider Business Mailing Address Fax Number:
973-667-0561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 FRANKLIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NUTLEY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07110-2900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-667-5511
Provider Business Practice Location Address Fax Number:
973-667-0561
Provider Enumeration Date:
07/16/2006

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: 207RC0000X , with the licence number:  25MA04356800 , 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: 803520 . This is a "COMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2010801 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 222420941001 . This is a "QUALCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 222420941004 . This is a "PRUDENTIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6396 . This is a "LIBERTY HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1021993002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 222420941 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4227367 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43K461 . This is a "EMPIRE WELL CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01000006500 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: PS211 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0041338 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060014377 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: OK6080 . This is a "PHYSICIANS HEALTH SERVICE" identifier . This identifiers is of the category "OTHER".




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