Provider Demographics
NPI:1427837145
Name:ARDIZZONE, TYLER MATTHEW (DPT)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:MATTHEW
Last Name:ARDIZZONE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LOCKWOOD PL
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-2508
Mailing Address - Country:US
Mailing Address - Phone:201-835-8943
Mailing Address - Fax:
Practice Address - Street 1:285A PASCACK RD
Practice Address - Street 2:
Practice Address - City:TOWNSHIP OF WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07676-4809
Practice Address - Country:US
Practice Address - Phone:201-358-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02208100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist