MEDICARE: DR. ELIZABETH C IADISERNIA DPT

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	225100000X	Physical Therapist	40QA01941600	NJ

General Provider Information

NPI Number	:	1316548753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH C IADISERNIA DPT

Provider Business Mailing Address
First Line	:	1801 MAIN ST STE 1B
Second Line	:
City	:	LAKE COMO
State	:	NJ
Zip	:	07719-2972
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 MAIN ST STE 1B
Second Line	:
City	:	LAKE COMO
State	:	NJ
Zip	:	07719-2972
Country	:	US
Telephone Number	:	732-256-1758
Fax Number	:

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

Provider Enumeration Date	:	11/03/2020
Last Update Date	:	05/19/2026

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