Healthcare Provider Details

I. General information

NPI: 1427886803
Provider Name (Legal Business Name): MICAELA MIZSAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 ERNSTON RD
PARLIN NJ
08859-1943
US

IV. Provider business mailing address

400 MATAWAN AVE APT 93C
CLIFFWOOD NJ
07721-3010
US

V. Phone/Fax

Practice location:
  • Phone: 732-316-4050
  • Fax:
Mailing address:
  • Phone: 732-773-0402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06568900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: