Individual provider Active NPI

Peter Marusca, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Woodside, NY
National Provider Identifier
1891308615
Registry record updated Jul 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
431837 Issued in NY
Practice address
4610 61St St Apt 14a
Woodside, NY 11377-5731
Phone
(347) 207-6654
NPI assigned
Aug 31, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 431837 NY Primary

Addresses

Primary practice location

4610 61St St Apt 14a
Woodside, NY 11377-5731

Mailing address

8146 Old Sunridge Dr
Manlius, NY 13104-2204
Phone (347) 207-6654

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210111002508 NY Practitioner - Nurse Practitioner 0244643278 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Suny Health Science Center at SyracuseGroup PAC ID 7214833086, 210 clinicians

Practice addresses (Care Compare)

750 E Adams St
Syracuse, NY 13210-2306
Phone (315) 464-8093

Hospital & facility affiliations

  • University Hospital S U N Y Health Science Center Hospital, Syracuse, NY, CCN 330241

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Suny Health Science Center at Syracuse CurrentSince Sep 25, 2025 Accepting new patients
Suny Health Science Center at Syracuse Acute Care CurrentSince Sep 25, 2025 Accepting new patients
Suny Health Science Center at Syracuse Past Accepting new patients

Locations

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

Interoperability endpoints

  • Direct secure messaging: pmarusca172137@direct.upstate.edu

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751500800000",
    "number": "1891308615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8146 OLD SUNRIDGE DR",
            "city": "MANLIUS",
            "state": "NY",
            "postal_code": "131042204",
            "telephone_number": "347-207-6654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4610 61ST ST APT 14A",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113775731",
            "telephone_number": "347-207-6654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARUSCA",
        "first_name": "PETER",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-31",
        "last_updated": "2025-07-03",
        "certification_date": "2025-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NY",
            "license": "431837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodside, NY

Sources for this page

Verify at the official NPI Registry.