Provider Demographics
NPI:1316385263
Name:FISCO, ERICK JAMES (MS OT)
Entity Type:Individual
Prefix:MR
First Name:ERICK
Middle Name:JAMES
Last Name:FISCO
Suffix:
Gender:M
Credentials:MS OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-4101
Mailing Address - Country:US
Mailing Address - Phone:732-406-4644
Mailing Address - Fax:
Practice Address - Street 1:16 AZALEA DR
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-4101
Practice Address - Country:US
Practice Address - Phone:732-406-4644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC010000875225X00000X
TX115286225X00000X
PAOC015226225X00000X
CA13457225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist