Provider Demographics
NPI:1275080137
Name:LUKASZCZYK, JANE ANGELA (COTA)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:ANGELA
Last Name:LUKASZCZYK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:WALLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07057-1211
Mailing Address - Country:US
Mailing Address - Phone:201-398-6929
Mailing Address - Fax:
Practice Address - Street 1:6612 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1719
Practice Address - Country:US
Practice Address - Phone:201-854-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant