Provider Demographics
NPI:1437319126
Name:EASTERN HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:EASTERN HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FUSARO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-691-0808
Mailing Address - Street 1:48 LEONARD DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-7920
Mailing Address - Country:US
Mailing Address - Phone:516-691-0808
Mailing Address - Fax:
Practice Address - Street 1:331 E 71ST ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4733
Practice Address - Country:US
Practice Address - Phone:212-288-2823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY229800OtherWORKERS COMPENSATION PROVIDER ID