Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N0040251 | NY |
Y | 222Z00000X | Podiatrist | N0040251 | NY |
NPI | 1013121649 |
---|---|
Provider Name | Victor J Fumuso |
First Address | Carle Place, NY 11514 |
Second Address | Carle Place, NY 11514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 12/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00924369 | (05) | NY |
0092982 | GHI (01) | NY |
480014059 | RR MEDICARE (01) | NY |
T51290 | (02) |