Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 102888 | NY |
NPI | 1033582507 |
---|---|
Provider Name | Richard Fuisz |
First Address | Bay Harbor Islands, FL 33154 |
Second Address | Bay Harbor Islands, FL 33154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2015 |
Last Update Date | 05/11/2015 |