Provider Demographics
NPI:1548246119
Name:SZITANKO, GARY JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JOSEPH
Last Name:SZITANKO
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 1:52 ROSALIE AVE
Mailing Address - Street 2:
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1323
Mailing Address - Country:US
Mailing Address - Phone:732-747-3195
Mailing Address - Fax:732-741-8290
Practice Address - Street 1:170 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5908
Practice Address - Country:US
Practice Address - Phone:732-741-5772
Practice Address - Fax:732-741-5778
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00612300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ095391Medicare ID - Type Unspecified