Healthcare Provider Details

I. General information

NPI: 1912686221
Provider Name (Legal Business Name): JESSICA CAPANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MARKET ST
SADDLE BROOK NJ
07663-5309
US

IV. Provider business mailing address

1902 BALTIMORE AVE
LAVALLETTE NJ
08735-2503
US

V. Phone/Fax

Practice location:
  • Phone: 201-368-6000
  • Fax:
Mailing address:
  • Phone: 201-575-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number46TR01130600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: