Healthcare Provider Details

I. General information

NPI: 1417214495
Provider Name (Legal Business Name): DIANA L LAUDATI COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 CLIFTON AVE STE 1A
CLIFTON NJ
07013-3619
US

IV. Provider business mailing address

539 JORALEMON ST #4
BELLEVILLE NJ
07109-1833
US

V. Phone/Fax

Practice location:
  • Phone: 973-246-6565
  • Fax: 973-883-0140
Mailing address:
  • Phone: 973-759-4182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number46TA09003200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: