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General NPI Number Information
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NPI Number | 1407247703
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Entity Type | Individual
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Provider Name | DR. ANTONIO MICHAEL COUZO
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Gender | Male
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | A2 CORNWALL DR
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3352
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Country | US
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Telephone | 732-619-5324
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Fax |
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Provider Business Mailing Address
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Address Line | 8 HARRISON ST
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City | SAYREVILLE
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State | NJ
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Zip | 08872-1626
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Country | US
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Telephone | 732-619-5324
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 22D102587900
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License Number State | NJ
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