Provider Demographics
NPI:1891552634
Name:ROZGONYI, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ROZGONYI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 COLUMBIA TPKE STE 105
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1229
Mailing Address - Country:US
Mailing Address - Phone:973-765-9050
Mailing Address - Fax:
Practice Address - Street 1:256 COLUMBIA TPKE STE 105
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1229
Practice Address - Country:US
Practice Address - Phone:973-765-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07088700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker