Healthcare Provider Details

I. General information

NPI: 1003566977
Provider Name (Legal Business Name): BROOKE ELIZABETH KUENZLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 BROAD ST
BLOOMFIELD NJ
07003-2885
US

IV. Provider business mailing address

291 PERIAQUA LN
MANTOLOKING NJ
08738-1020
US

V. Phone/Fax

Practice location:
  • Phone: 973-404-7067
  • Fax:
Mailing address:
  • Phone: 201-316-4010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR01047200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: