Provider Demographics
NPI:1891252359
Name:ROSZKOWSKI, AGNES (COTA/L)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:ROSZKOWSKI
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 W 42ND ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3061
Mailing Address - Country:US
Mailing Address - Phone:201-377-5531
Mailing Address - Fax:
Practice Address - Street 1:104 PENSION RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8400
Practice Address - Country:US
Practice Address - Phone:732-446-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09168400224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ46TA09168400OtherSTATE OF NEW JERSEY