Healthcare Provider Details

I. General information

NPI: 1063587988
Provider Name (Legal Business Name): SHELLA ZARAGOZA CAJITA P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 BROAD AVE
RIDGEFIELD NJ
07657-1055
US

IV. Provider business mailing address

481A FR. CAPODANNO BLVD. STE. 1
STATEN ISLAND NY
10305
US

V. Phone/Fax

Practice location:
  • Phone: 908-301-6134
  • Fax: 908-301-6586
Mailing address:
  • Phone: 718-720-3790
  • Fax: 718-720-1238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number019545
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: