Basic Information
| Provider Information | |||||||||
| NPI: | 1376563452 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FUSELLA | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 TROY SCHENECTADY RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187823700 | ||||||||
| FaxNumber: | 5187823799 | ||||||||
| Practice Location | |||||||||
| Address1: | 2125 RIVER RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | SCHENECTADY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 123091135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183469682 | ||||||||
| FaxNumber: | 5183469693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 01/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 174880 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000401415001 | 01 | NY | BSNENY | OTHER | 200304 | 01 | NY | SENIOR WHOLE HEALTH | OTHER | 47332 | 01 | NY | GHI/HMO | OTHER | 691791 | 01 | NY | EMPIRE BC | OTHER | 01463414 | 05 | NY | MEDICAID | 10000717 | 01 | NY | CDPHP | OTHER | 5996338 | 01 | NY | AETNA | OTHER | 070125000019 | 01 | NY | FIDELIS | OTHER | 08191 | 01 | NY | MVP | OTHER |