Provider Demographics
NPI:1609065788
Name:FOSCO, STEFAN J
Entity Type:Individual
Prefix:MR
First Name:STEFAN
Middle Name:J
Last Name:FOSCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EMPIRE DR
Mailing Address - Street 2:STE 204
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-5730
Mailing Address - Country:US
Mailing Address - Phone:518-382-4550
Mailing Address - Fax:
Practice Address - Street 1:2 EMPIRE DR STE 204
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144
Practice Address - Country:US
Practice Address - Phone:518-283-6111
Practice Address - Fax:518-283-6161
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0018631231H00000X
NY001863-1231HA2400X, 231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter