Provider Demographics
NPI:1437379567
Name:HERZOG, CAREN LISA (OT)
Entity Type:Individual
Prefix:MRS
First Name:CAREN
Middle Name:LISA
Last Name:HERZOG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CAREN
Other - Middle Name:LISA
Other - Last Name:LIVNI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:72 MOHAWK TRL
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5030
Mailing Address - Country:US
Mailing Address - Phone:973-449-4786
Mailing Address - Fax:973-839-6921
Practice Address - Street 1:65 BERGEN ST
Practice Address - Street 2:ROOM 601- NEWARK THERAPY SERVICES
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-3001
Practice Address - Country:US
Practice Address - Phone:973-972-0186
Practice Address - Fax:973-972-2645
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00088800225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics