Provider Demographics
NPI:1942492681
Name:FUSCO, NATALIE ROSE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:ROSE
Last Name:FUSCO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 BEL AIR DRIVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-3209
Mailing Address - Country:US
Mailing Address - Phone:516-541-2054
Mailing Address - Fax:516-541-3541
Practice Address - Street 1:268 BEL AIR DRIVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-3209
Practice Address - Country:US
Practice Address - Phone:516-541-2054
Practice Address - Fax:516-541-3541
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0948161164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02603354Medicaid