Healthcare Provider Details

I. General information

NPI: 1578219119
Provider Name (Legal Business Name): DIANE B ZAGORSKI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 02/22/2022
Certification Date: 02/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 RIVER RD
SUMMIT NJ
07901-1306
US

IV. Provider business mailing address

3404 PARK PL
SPRINGFIELD NJ
07081-3500
US

V. Phone/Fax

Practice location:
  • Phone: 908-830-0504
  • Fax:
Mailing address:
  • Phone: 908-305-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01077900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: