Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 466TR00199200 | NJ |
NPI | 1235603895 |
---|---|
Provider Name | Lisa Colleen Carlomagno |
First Address | Northvale, NJ 07647-1814 |
Second Address | Rockleigh, NJ 07647-2504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2019 |
Last Update Date | 17/01/2019 |