Provider Demographics
NPI:1275286981
Name:BUZZETTA, JUSTINE (PT)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:BUZZETTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:
Other - Last Name:SPERANDEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2219
Mailing Address - Country:US
Mailing Address - Phone:917-848-0274
Mailing Address - Fax:
Practice Address - Street 1:3 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2219
Practice Address - Country:US
Practice Address - Phone:917-848-0274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01111100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist