Provider Demographics
NPI:1780966341
Name:BROZYNA, NICOLE LAUREN (OT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LAUREN
Last Name:BROZYNA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:MINIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:290 LAKEVIEW AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-4054
Mailing Address - Country:US
Mailing Address - Phone:631-807-5081
Mailing Address - Fax:
Practice Address - Street 1:3196 KENNEDY BLVD
Practice Address - Street 2:
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?:Yes
Enumeration Date:2011-09-09
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00519000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist