Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 134450 | NY |
NPI | 1225009889 |
---|---|
Provider Name | Judy Fuschino |
First Address | Clifton Park, NY 12065-2701 |
Second Address | Troy, NY 12180-2075 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 03/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00516578 | (05) | NY |
10005667 | CDPHP (01) | NY |