Healthcare Provider Details

I. General information

NPI: 1528889086
Provider Name (Legal Business Name): DARLENE MARIE KUZLOSKI LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 ROUTE 88
POINT PLEASANT BORO NJ
08742-2247
US

IV. Provider business mailing address

2400 ROUTE 88
POINT PLEASANT BORO NJ
08742-2247
US

V. Phone/Fax

Practice location:
  • Phone: 732-709-9355
  • Fax:
Mailing address:
  • Phone: 732-267-6551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37AC00793200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: