Provider Demographics
NPI:1225009889
Name:FUSCHINO, JUDY (MD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:FUSCHINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CRESTHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-2701
Mailing Address - Country:US
Mailing Address - Phone:518-371-0839
Mailing Address - Fax:518-371-0839
Practice Address - Street 1:333 HOOSICK ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2075
Practice Address - Country:US
Practice Address - Phone:518-273-3732
Practice Address - Fax:518-272-2993
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1344502080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10005667OtherCDPHP
NY00516578Medicaid