Healthcare Provider Details

I. General information

NPI: 1609343086
Provider Name (Legal Business Name): MRS. AVIVA KALUSZYNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 MONMOUTH AVE
LAKEWOOD NJ
08701-3210
US

IV. Provider business mailing address

422 MONMOUTH AVE
LAKEWOOD NJ
08701-3210
US

V. Phone/Fax

Practice location:
  • Phone: 732-917-3304
  • Fax:
Mailing address:
  • Phone: 732-917-3304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberCAPPA
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: