Healthcare Provider Details

I. General information

NPI: 1851371801
Provider Name (Legal Business Name): CORAZON CIPRIASO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TANGLEWOOD PL E
MONROE TWP NJ
08831-3268
US

IV. Provider business mailing address

PO BOX 790
OLD BRIDGE NJ
08857-0790
US

V. Phone/Fax

Practice location:
  • Phone: 908-601-5296
  • Fax: 866-506-2790
Mailing address:
  • Phone: 732-492-8241
  • Fax: 888-685-8722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number25MA07358200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MA07358200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: