Provider Demographics
NPI:1215545421
Name:AZZOPARDI, DEIRDRE (OTD)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:AZZOPARDI
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 WALTHERY AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3902
Mailing Address - Country:US
Mailing Address - Phone:201-689-0717
Mailing Address - Fax:
Practice Address - Street 1:26 WALTHERY AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3902
Practice Address - Country:US
Practice Address - Phone:201-689-0717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00198900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist