=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174833545
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALEX AND SUSAN COCOZIELLO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2010
-----------------------------------------------------
Last Update Date | 10/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 BROADWAY SUITE 303
-----------------------------------------------------
City | ELMWOOD PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-794-7717
-----------------------------------------------------
Fax | 201-794-0335
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ONE BROADWAY SUITE 303
-----------------------------------------------------
City | ELMWOOD PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-794-7717
-----------------------------------------------------
Fax | 201-795-0335
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | ALEXANDER COCOZIELLO
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 201-794-7717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------