Provider Demographics
NPI:1902142425
Name:FUSZARA, JESSICA M (MSED)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:M
Last Name:FUSZARA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 LONDONDERRY LN
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1168
Mailing Address - Country:US
Mailing Address - Phone:716-465-5444
Mailing Address - Fax:
Practice Address - Street 1:86 LONDONDERRY LN
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1168
Practice Address - Country:US
Practice Address - Phone:716-465-5444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJF477878OtherHEALTH COMMERCE SYSTEM (HCS)