Provider Demographics
NPI:1093012429
Name:MOCZERNIUK, LAUREN CARRIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:CARRIE
Last Name:MOCZERNIUK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:CARRIE
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:232 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764
Mailing Address - Country:US
Mailing Address - Phone:732-932-1500
Mailing Address - Fax:
Practice Address - Street 1:232 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1859
Practice Address - Country:US
Practice Address - Phone:732-923-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01253500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist