Healthcare Provider Details

I. General information

NPI: 1770853913
Provider Name (Legal Business Name): GELANIA YVONNE EADDY COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E LINDSLEY RD
CEDAR GROVE NJ
07009-1023
US

IV. Provider business mailing address

103 LINWOOD TER
CLIFTON NJ
07012-2336
US

V. Phone/Fax

Practice location:
  • Phone: 973-256-7220
  • Fax:
Mailing address:
  • Phone: 321-987-0225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number46TA09082200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: