Provider Demographics
NPI:1598007395
Name:SUSAN COCOZIELLO MD LLC
Entity type:Organization
Organization Name:SUSAN COCOZIELLO MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:PAKRAVAN
Authorized Official - Last Name:COCOZIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-794-7717
Mailing Address - Street 1:1 BROADWAY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-1842
Mailing Address - Country:US
Mailing Address - Phone:201-794-7717
Mailing Address - Fax:201-794-0335
Practice Address - Street 1:1 BROADWAY
Practice Address - Street 2:SUITE 303
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-1845
Practice Address - Country:US
Practice Address - Phone:201-794-7717
Practice Address - Fax:201-794-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB25981174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ162933Medicare PIN