Provider Demographics
NPI:1598875148
Name:PRUSAKOWSKI, JOSEPH M (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:PRUSAKOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-849-1874
Mailing Address - Fax:814-849-1444
Practice Address - Street 1:90 HOSPITAL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-1382
Practice Address - Country:US
Practice Address - Phone:814-849-1874
Practice Address - Fax:814-849-1444
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003498L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007277640001Medicaid
PA0007277640001Medicaid
PA74381Medicare PIN