Provider Demographics
NPI:1295780682
Name:CUOZZO, ROSALIE C (PA)
Entity type:Individual
Prefix:
First Name:ROSALIE
Middle Name:C
Last Name:CUOZZO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4059
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07474-4059
Mailing Address - Country:US
Mailing Address - Phone:973-826-8287
Mailing Address - Fax:855-834-5435
Practice Address - Street 1:484 ROUTE 134
Practice Address - Street 2:
Practice Address - City:SOUTH DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660-3423
Practice Address - Country:US
Practice Address - Phone:508-694-7901
Practice Address - Fax:508-694-7898
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00054700363AS0400X
UT7008020-1206363AS0400X
MAPA8687363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ088103Medicare PIN
Q35960Medicare UPIN
NJ257181YP69Medicare PIN