Provider Demographics
NPI:1093991606
Name:SHMARUK, EDWARD (DC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:SHMARUK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37-09 GARDENVIEW TERRACE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410
Mailing Address - Country:US
Mailing Address - Phone:201-819-9748
Mailing Address - Fax:
Practice Address - Street 1:37-09 GARDEN VIEW TER
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-4360
Practice Address - Country:US
Practice Address - Phone:201-819-9748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00663600111N00000X
PADC009895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor