Provider Demographics
NPI:1952452997
Name:FUSCO-PULEO, TARA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MARIE
Last Name:FUSCO-PULEO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:MARIE
Other - Last Name:FUSCO-PULEO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:165 N VILLAGE AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3761
Mailing Address - Country:US
Mailing Address - Phone:516-536-7200
Mailing Address - Fax:516-536-7208
Practice Address - Street 1:165 N VILLAGE AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3761
Practice Address - Country:US
Practice Address - Phone:516-536-7200
Practice Address - Fax:516-536-7208
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208013208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics