Provider Demographics
NPI:1376563452
Name:FUSELLA, JOSEPH P (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:P
Last Name:FUSELLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:2125 RIVER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-1135
Practice Address - Country:US
Practice Address - Phone:518-346-9682
Practice Address - Fax:518-346-9693
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000401415001OtherBSNENY
NY200304OtherSENIOR WHOLE HEALTH
NY47332OtherGHI/HMO
NY691791OtherEMPIRE BC
NY01463414Medicaid
NY10000717OtherCDPHP
NY5996338OtherAETNA
NY070125000019OtherFIDELIS
NY08191OtherMVP
NY5996338OtherAETNA
NY01463414Medicaid