Healthcare Provider Details

I. General information

NPI: 1073316451
Provider Name (Legal Business Name): GRACE VICTORIA CIOCCI COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 LAKEVIEW AVE
CLIFTON NJ
07011-4011
US

IV. Provider business mailing address

214 MEADOWBROOK AVE
WANAQUE NJ
07465-1200
US

V. Phone/Fax

Practice location:
  • Phone: 862-238-7000
  • Fax:
Mailing address:
  • Phone: 201-937-9950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number46TA09167300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: