Provider Demographics
NPI:1407247703
Name:COUZO, ANTONIO MICHAEL
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:MICHAEL
Last Name:COUZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-1626
Mailing Address - Country:US
Mailing Address - Phone:732-619-5324
Mailing Address - Fax:
Practice Address - Street 1:A2 CORNWALL DR
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3352
Practice Address - Country:US
Practice Address - Phone:732-619-5324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D102587900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist