Healthcare Provider Details

I. General information

NPI: 1295780682
Provider Name (Legal Business Name): ROSALIE C CUOZZO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

484 ROUTE 134
SOUTH DENNIS MA
02660-3423
US

IV. Provider business mailing address

PO BOX 4059
WAYNE NJ
07474-4059
US

V. Phone/Fax

Practice location:
  • Phone: 508-694-7901
  • Fax: 508-694-7898
Mailing address:
  • Phone: 973-826-8287
  • Fax: 855-834-5435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00054700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number7008020-1206
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA8687
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: