Individual provider Active NPI

Mariya Fuzaylova, OTR/L

  • Occupational Therapist
  • Bronx, NY
National Provider Identifier
1700019783
Registry record updated Nov 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
013231 Issued in NY
Practice address
721 Melrose Ave
Bronx, NY 10455-1121
Phone
(718) 554-0064
Fax
(718) 554-0221
NPI assigned
Aug 25, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 26, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 013231 NY Primary

Addresses

Primary practice location

721 Melrose Ave
Bronx, NY 10455-1121

Mailing address

721 Melrose Ave
Bronx, NY 10455-1121
Phone (718) 554-0064

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060210000282 NY Practitioner - Occupational Therapist in Private Practice 2466467568 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optimal Rehabilitation Otandpt PLLCGroup PAC ID 2264602135, 2 clinicians

Practice addresses (Care Compare)

721 Melrose Ave
Bronx, NY 10455-1121
Phone (718) 554-0064

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
013231NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Optimal Rehabilitation OT&PT PLLC CurrentSince Jul 1, 2011 Accepting new patients
Em Physical Therapy PC Occupational Therapist Past Accepting new patients

Locations

4011 Warren St
Ste 2
Elmhurst, NY 11373
Phone (516) 428-8364

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1251158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543190400000",
    "number": "1700019783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 MELROSE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104551121",
            "telephone_number": "718-554-0064",
            "fax_number": "718-554-0221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 MELROSE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104551121",
            "telephone_number": "718-554-0064",
            "fax_number": "718-554-0221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUZAYLOVA",
        "first_name": "MARIYA",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-08-25",
        "last_updated": "2018-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "013231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.