Provider Demographics
NPI:1093374563
Name:CORRALIZZA, ALEXIS DANIELLE
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:DANIELLE
Last Name:CORRALIZZA
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 1:195 NANTUCKET PL
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1741
Mailing Address - Country:US
Mailing Address - Phone:732-213-4550
Mailing Address - Fax:
Practice Address - Street 1:210 MOUNTS CORNER DR
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2547
Practice Address - Country:US
Practice Address - Phone:732-414-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09178500224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty