Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 264468 | NY |
NPI | 1013177674 |
---|---|
Provider Name | Heidi N Fusco |
First Address | New York, NY 10029-6501 |
Second Address | New York, NY 10016-2708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2008 |
Last Update Date | 08/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R70155 | TRAINING PERMIT (01) | AZ |