Provider Demographics
NPI:1053398065
Name:FUKSINA, NATASHA A (MD)
Entity type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:A
Last Name:FUKSINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-1338
Mailing Address - Country:US
Mailing Address - Phone:973-483-1500
Mailing Address - Fax:973-483-4577
Practice Address - Street 1:550 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-1338
Practice Address - Country:US
Practice Address - Phone:973-483-1500
Practice Address - Fax:973-483-4577
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07003100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ364544263OtherTAX ID NUMBER
NJ364544263OtherTAX ID NUMBER
NJH49343Medicare UPIN