Provider Demographics
NPI:1043376692
Name:SZYMCZAK, MARK (DPT)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:SZYMCZAK
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 1:140 MALLINSON ST
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401-1918
Mailing Address - Country:US
Mailing Address - Phone:201-841-5555
Mailing Address - Fax:201-773-9701
Practice Address - Street 1:9 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-1529
Practice Address - Country:US
Practice Address - Phone:201-773-9700
Practice Address - Fax:201-773-9701
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA008981225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ069241Medicare ID - Type Unspecified