Provider Demographics
NPI:1053075291
Name:DADEZZIO, THERESE G
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:G
Last Name:DADEZZIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1196 FOSTER TER
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-1749
Mailing Address - Country:US
Mailing Address - Phone:908-405-6973
Mailing Address - Fax:
Practice Address - Street 1:1 MAIN ST STE 505
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3903
Practice Address - Country:US
Practice Address - Phone:732-493-3100
Practice Address - Fax:732-876-4967
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01016500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty