Healthcare Provider Details

I. General information

NPI: 1477441525
Provider Name (Legal Business Name): JULIANA MAZZOTTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 UNION ST STE 2
HACKENSACK NJ
07601-4354
US

IV. Provider business mailing address

770 JACKSON ST APT 304
HOBOKEN NJ
07030-6983
US

V. Phone/Fax

Practice location:
  • Phone: 201-646-9090
  • Fax:
Mailing address:
  • Phone: 203-858-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number011178
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00742300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: