Provider Demographics
NPI:1790702678
Name:FUSILLI, LOUIS D (MD FACC)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:D
Last Name:FUSILLI
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2900
Mailing Address - Country:US
Mailing Address - Phone:973-667-5511
Mailing Address - Fax:973-667-0561
Practice Address - Street 1:181 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2900
Practice Address - Country:US
Practice Address - Phone:973-667-5511
Practice Address - Fax:973-667-0561
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04356800207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
803520OtherCOMED
NJ2010801Medicaid
222420941001OtherQUALCARE
222420941004OtherPRUDENTIAL
6396OtherLIBERTY HEALTH PLANS
1021993002OtherCIGNA
222420941OtherBLUE CROSS BLUE SHIELD
4227367OtherAETNA PPO
43K461OtherEMPIRE WELL CHOICE
01000006500OtherAMERICHOICE
PS211OtherOXFORD
0041338OtherAETNA HMO
060014377OtherUNITED HEALTH CARE
OK6080OtherPHYSICIANS HEALTH SERVICE
803520OtherCOMED
6396OtherLIBERTY HEALTH PLANS