Provider Demographics
NPI:1750592853
Name:FUSARO, GERARD JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:JAMES
Last Name:FUSARO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 LEONARD DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-7920
Mailing Address - Country:US
Mailing Address - Phone:516-410-3640
Mailing Address - Fax:212-208-4648
Practice Address - Street 1:230 E 48TH ST # 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1509
Practice Address - Country:US
Practice Address - Phone:516-410-3640
Practice Address - Fax:212-288-2713
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX033339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY229800OtherWCB