Provider Demographics
NPI:1861655243
Name:CIRAULO, JENNIFER ANN (MS, OTR)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:CIRAULO
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 LOTTE RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4825
Mailing Address - Country:US
Mailing Address - Phone:201-396-8694
Mailing Address - Fax:
Practice Address - Street 1:3196 KENNEDY BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2436
Practice Address - Country:US
Practice Address - Phone:201-223-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00374800225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics