Provider Demographics
NPI:1538901541
Name:MORFOGEN, ZAHAROULA (LAAT)
Entity type:Individual
Prefix:
First Name:ZAHAROULA
Middle Name:
Last Name:MORFOGEN
Suffix:
Gender:F
Credentials:LAAT
Other - Prefix:
Other - First Name:ZACHAROULA
Other - Middle Name:
Other - Last Name:MORFOGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2056 JOHN F KENNEDY BLVD APT 2C
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1581
Mailing Address - Country:US
Mailing Address - Phone:732-580-3553
Mailing Address - Fax:
Practice Address - Street 1:185 BROADWAY STE 1
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NJ
Practice Address - Zip Code:07642-2746
Practice Address - Country:US
Practice Address - Phone:845-793-2657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ16LA00000200221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist