Provider Demographics
NPI:1487217238
Name:PRATA, SAMUEL (DPT)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:PRATA
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:MANUFACTURERS PL # 2
Mailing Address - Street 2:1
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105
Mailing Address - Country:US
Mailing Address - Phone:973-465-4410
Mailing Address - Fax:
Practice Address - Street 1:275 CHESTNUT ST # 169
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1570
Practice Address - Country:US
Practice Address - Phone:973-465-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJFEF417A111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJSAMUEL8Medicaid