Provider Demographics
NPI:1467559195
Name:SCHUPAK, BARBARA MARION (MPH,OTR)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:MARION
Last Name:SCHUPAK
Suffix:
Gender:F
Credentials:MPH,OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-2151
Mailing Address - Country:US
Mailing Address - Phone:201-244-0844
Mailing Address - Fax:201-384-1779
Practice Address - Street 1:10 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-2151
Practice Address - Country:US
Practice Address - Phone:201-244-0844
Practice Address - Fax:201-384-1779
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00063600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ035598Medicare ID - Type Unspecified