Provider Demographics
NPI:1821063819
Name:DIAZ, OZZIE ALEXANDER (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:OZZIE
Middle Name:ALEXANDER
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-2410
Mailing Address - Country:US
Mailing Address - Phone:973-835-5858
Mailing Address - Fax:
Practice Address - Street 1:51 CONFORTI AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2829
Practice Address - Country:US
Practice Address - Phone:973-669-5301
Practice Address - Fax:973-669-8605
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000661002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer