Provider Demographics
NPI:1528367455
Name:BANASZAK, STEVEN
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:BANASZAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 STADIUM ST
Mailing Address - Street 2:GATEWAY NORTH CENTER
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-2899
Mailing Address - Country:US
Mailing Address - Phone:302-659-0173
Mailing Address - Fax:302-659-0424
Practice Address - Street 1:207 STADIUM ST
Practice Address - Street 2:GATEWAY NORTH CENTER
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-2899
Practice Address - Country:US
Practice Address - Phone:302-659-0173
Practice Address - Fax:302-659-0424
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist