MEDICARE: DIANA CORTICEIRO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	TL-4092	NJ

General Provider Information

NPI Number	:	1225712383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA CORTICEIRO

Provider Business Mailing Address
First Line	:	101 LAFAYETTE CT
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-1493
Country	:	US
Telephone Number	:	732-406-4168
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 CORNWALL DR STE 203
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-3332
Country	:	US
Telephone Number	:	732-406-4168
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2023
Last Update Date	:	05/27/2026

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Directions to “ DIANA CORTICEIRO ” Practice Location

Language	Start Address	Practice Location

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