Provider Demographics
NPI:1922564509
Name:FRUSCIANTE, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:FRUSCIANTE
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 1:116 MAIN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4410
Mailing Address - Country:US
Mailing Address - Phone:973-420-5074
Mailing Address - Fax:
Practice Address - Street 1:471 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-2138
Practice Address - Country:US
Practice Address - Phone:845-331-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor