Healthcare Provider Details

I. General information

NPI: 1912839663
Provider Name (Legal Business Name): JUSTINA DIANN CUTOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 FRANKLIN LAKE RD STE 204
FRANKLIN LAKES NJ
07417-2267
US

IV. Provider business mailing address

298 WINDSOR RD
WOOD RIDGE NJ
07075-1118
US

V. Phone/Fax

Practice location:
  • Phone: 201-381-6136
  • Fax:
Mailing address:
  • Phone: 973-513-0216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS01196200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: