Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 46TR00214500 | NJ |
N | 225XP0200X | Occupational Therapist - Pediatrics | 46TR00214500 | NJ |
NPI | 1558751388 |
---|---|
Provider Name | Regina Ardizone |
First Address | Park Ridge, NJ 07656-2515 |
Second Address | Park Ridge, NJ 07656-2515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2015 |
Last Update Date | 02/02/2015 |