Provider Demographics
NPI:1417719717
Name:JUSCZAK, JOSEF STANLEY (BSN, RN)
Entity Type:Individual
Prefix:
First Name:JOSEF
Middle Name:STANLEY
Last Name:JUSCZAK
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BARKER ST # 1
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01850-1405
Mailing Address - Country:US
Mailing Address - Phone:978-430-1037
Mailing Address - Fax:
Practice Address - Street 1:15 BARKER ST # 1
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01850-1405
Practice Address - Country:US
Practice Address - Phone:978-430-1037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2350968163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse