Provider Demographics
NPI:1891308615
Name:MARUSCA, PETER (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:MARUSCA
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 61ST ST APT 14A
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-5731
Mailing Address - Country:US
Mailing Address - Phone:347-207-6654
Mailing Address - Fax:
Practice Address - Street 1:4610 61ST ST APT 14A
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5731
Practice Address - Country:US
Practice Address - Phone:347-207-6654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431837363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care