Provider Demographics
NPI:1306068325
Name:FUSCO, EILEEN F (NP)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:F
Last Name:FUSCO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E 34TH ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4750
Mailing Address - Country:US
Mailing Address - Phone:212-731-5177
Mailing Address - Fax:212-731-6009
Practice Address - Street 1:26 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2511
Practice Address - Country:US
Practice Address - Phone:515-354-5077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
301982261QX0200X
NY301982363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner