Provider Demographics
NPI:1972191427
Name:CUZZOLA, ANGELICA (MOT)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:CUZZOLA
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 NEW YORK AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-1783
Mailing Address - Country:US
Mailing Address - Phone:732-713-2946
Mailing Address - Fax:
Practice Address - Street 1:105 GROVE ST STE 14
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4053
Practice Address - Country:US
Practice Address - Phone:917-587-0407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00782100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty