Provider Demographics
NPI:1174996581
Name:FUSI AND CRAIG PLASTIC SURGERY, PA
Entity type:Organization
Organization Name:FUSI AND CRAIG PLASTIC SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEFANO
Authorized Official - Middle Name:
Authorized Official - Last Name:FUSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-605-0420
Mailing Address - Street 1:1544 SAWDUST RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2929
Mailing Address - Country:US
Mailing Address - Phone:281-292-7411
Mailing Address - Fax:281-292-7481
Practice Address - Street 1:5 DURHAM RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2076
Practice Address - Country:US
Practice Address - Phone:203-458-4444
Practice Address - Fax:203-458-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5803174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty