MEDICARE: ADA FUSCO MSOT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	028547	NY

General Provider Information

NPI Number	:	1851164198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADA FUSCO MSOT

Provider Business Mailing Address
First Line	:	7715 11TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2315
Country	:	US
Telephone Number	:	646-641-9332
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 PAVONIA AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-2920
Country	:	US
Telephone Number	:	201-409-1417
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	02/11/2026

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