Individual provider Active NPI

Tara Marie Fusco-Puleo, M.D.

  • Pediatrics Physician
  • Rockville Centre, NY
National Provider Identifier
1952452997
Registry record updated Mar 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
208013 Issued in NY
Practice address
165 N Village Ave
Suite 215
Rockville Centre, NY 11570-3761
Phone
(516) 536-7200
Fax
(516) 536-7208
NPI assigned
Jan 16, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 208013 NY Primary

Addresses

Primary practice location

165 N Village Ave
Suite 215
Rockville Centre, NY 11570-3761

Mailing address

165 N Village Ave
Suite 215
Rockville Centre, NY 11570-3761
Phone (516) 536-7200

Other names 1

  • Tara Marie Fusco-Puleo Other name

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201023000619 NY Practitioner - Pediatric Medicine 0244650687 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
208013NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2022 Accepting new patients
Optum Medical Care, P.C. CurrentSince Sep 1, 2022 Accepting new patients
Mount Kisco Medical Group Past Accepting new patients

Locations

2322 30th Ave
Astoria, NY 11102
Phone (718) 267-2763

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

110 S Bedford Rd
Mount Kisco, NY 10549
Phone (763) 910-9192

Philadelphia, PA 19195

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.

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269907200000",
    "number": "1952452997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 N VILLAGE AVE",
            "address_2": "SUITE 215",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115703761",
            "telephone_number": "516-536-7200",
            "fax_number": "516-536-7208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 N VILLAGE AVE",
            "address_2": "SUITE 215",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115703761",
            "telephone_number": "516-536-7200",
            "fax_number": "516-536-7208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUSCO-PULEO",
        "first_name": "TARA",
        "middle_name": "MARIE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-16",
        "last_updated": "2010-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "208013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "FUSCO-PULEO",
            "middle_name": "MARIE",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Rockville Centre, NY

Sources for this page

Verify at the official NPI Registry.