Healthcare Provider Details

I. General information

NPI: 1952985236
Provider Name (Legal Business Name): BRANDON VACCARO COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 JACKSONVILLE RD
BURLINGTON TOWNSHIP NJ
08016-3858
US

IV. Provider business mailing address

47 VAN DYKE RD
HOPEWELL NJ
08525-1216
US

V. Phone/Fax

Practice location:
  • Phone: 609-239-3900
  • Fax:
Mailing address:
  • Phone: 609-731-5776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number46TA09209700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: