Provider Demographics
NPI:1083686752
Name:VANBUSKIRK, MARYJO (PT)
Entity Type:Individual
Prefix:
First Name:MARYJO
Middle Name:
Last Name:VANBUSKIRK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:SUMMIT MEDICAL GROUP
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:908-228-3631
Practice Address - Street 1:1 DIAMOND HILL RD
Practice Address - Street 2:SUMMIT MEDICAL GROUP
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2104
Practice Address - Country:US
Practice Address - Phone:908-273-4300
Practice Address - Fax:908-228-3631
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00266400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ26620Medicare UPIN
NJ084627BSDMedicare ID - Type Unspecified