Provider Demographics
NPI:1467969238
Name:COZZARELLI, ROBERT JR (DPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:COZZARELLI
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16-14 HUNTER PL
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5209
Mailing Address - Country:US
Mailing Address - Phone:201-407-8047
Mailing Address - Fax:
Practice Address - Street 1:155 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-2407
Practice Address - Country:US
Practice Address - Phone:973-450-0878
Practice Address - Fax:973-450-1013
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01550300208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation