Provider Demographics
NPI:1154407500
Name:FUSARO, MICHAEL ERNEST (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ERNEST
Last Name:FUSARO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2813
Mailing Address - Country:US
Mailing Address - Phone:973-857-9656
Mailing Address - Fax:
Practice Address - Street 1:32 HINE ST
Practice Address - Street 2:SUITE 212
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2955
Practice Address - Country:US
Practice Address - Phone:973-742-9111
Practice Address - Fax:973-742-9017
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD02486213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP1988634OtherOXFORD PIN
NJ1110186Medicaid
NJ7773102Medicaid
NJ1K6547OtherHELATHNET
NJP1988634OtherOXFORD PIN
NJU72992Medicare UPIN