Active NPI
Gina Dazos
- Physical Therapy Assistant
- Maplewood, NJ
National Provider Identifier
1548686991
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 40QB00100800
- Practice address
- 333 Elmwood Avenue
Maplewood, NJ 07040 - Phone
- (973) 313-2104
- NPI assigned
- Mar 10, 2014
- Last updated
- Mar 10, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 40QB00100800 | NJ | Primary |
Addresses
Primary practice location
333 Elmwood Avenue
Maplewood, NJ 07040
Mailing address
92 Mildred Terrace
Clark, NJ 07066
Phone (732) 882-6269
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40QB00100800 | NJ | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1394409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1394409600000",
"number": "1548686991",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "92 MILDRED TERRACE",
"city": "CLARK",
"state": "NJ",
"postal_code": "07066",
"telephone_number": "732-882-6269"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 ELMWOOD AVENUE",
"city": "MAPLEWOOD",
"state": "NJ",
"postal_code": "07040",
"telephone_number": "973-313-2104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAZOS",
"first_name": "GINA",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-03-10",
"last_updated": "2014-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NJ",
"license": "40QB00100800",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maplewood, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.