Provider Demographics
NPI:1780664821
Name:FUSARO, JAMES MARIANO (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MARIANO
Last Name:FUSARO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 CORLIES AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4908
Mailing Address - Country:US
Mailing Address - Phone:732-774-8900
Mailing Address - Fax:732-988-4619
Practice Address - Street 1:1706 CORLIES AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4908
Practice Address - Country:US
Practice Address - Phone:732-774-8900
Practice Address - Fax:732-988-4619
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA042987208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJJF0388H10OtherEMPIRE WELLCHOICE
NJ2K2123OtherHEALTH NET
NJ3327604Medicaid
NJ4093761OtherAETNA ID
NJMS081OtherOXFORD ID
NJT3625OtherNJ MANUFACTURER WKMNS
NJUNITED HEALTHCAREOtherUNITED HEALTHCARE
NJ0198878OtherGHI ID
NJ0198878OtherGHI ID
NJJF0388H10OtherEMPIRE WELLCHOICE