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Individual

MS. GINA DAZOS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
333 ELMWOOD AVENUE, MAPLEWOOD, NJ 07040
(973) 313-2104
Mailing address
92 MILDRED TERRACE, CLARK, NJ 07066
(732) 882-6269

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
40QB00100800
NJ

Other

Enumeration date
03/10/2014
Last updated
03/10/2014
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