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General NPI Number Information
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NPI Number | 1073687356
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Entity Type | Individual
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Provider Name | SUSAN PAKRAVAN COCOZIELLO M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 09/06/2019
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Provider Practice Location Address
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Address Line | 1 BROADWAY SUITE 105
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City | ELMWOOD PARK
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State | NJ
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Zip | 07407-1842
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Country | US
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Telephone | 201-773-6777
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Fax | 201-300-6880
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Provider Business Mailing Address
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Address Line | 1 BROADWAY STE 105
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City | ELMWOOD PARK
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State | NJ
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Zip | 07407-1843
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Country | UM
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Telephone | 201-794-7717
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Fax | 201-794-7717
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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