Healthcare Provider Details

I. General information

NPI: 1326118944
Provider Name (Legal Business Name): LAUREN ZICHELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S LIVINGSTON AVE
LIVINGSTON NJ
07039-4043
US

IV. Provider business mailing address

201 S LIVINGSTON AVE
LIVINGSTON NJ
07039-4043
US

V. Phone/Fax

Practice location:
  • Phone: 973-716-0033
  • Fax: 973-716-0073
Mailing address:
  • Phone: 973-716-0033
  • Fax: 973-716-0073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00838800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: