Provider Demographics
NPI:1942270616
Name:DEFUSCO, CARMINE JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMINE
Middle Name:JOSEPH
Last Name:DEFUSCO
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:ATRIUM MEDICAL ARTS, SUITE 106
Mailing Address - Street 2:224 TAYLORS MILLS RD
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3281
Mailing Address - Country:US
Mailing Address - Phone:732-462-0666
Mailing Address - Fax:732-462-0992
Practice Address - Street 1:224 TAYLOR MILLS RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3281
Practice Address - Country:US
Practice Address - Phone:732-462-0666
Practice Address - Fax:732-462-0992
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA35320207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJDE453762Medicare ID - Type UnspecifiedMEDICARE #
NJC55505Medicare UPIN