Provider Demographics
NPI:1558844753
Name:KERNOSCHAK, CARA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:KERNOSCHAK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 LAKE JUST IT RD
Mailing Address - Street 2:
Mailing Address - City:BLAIRSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07825-3823
Mailing Address - Country:US
Mailing Address - Phone:908-619-6823
Mailing Address - Fax:
Practice Address - Street 1:135 ROUTE 46 EAST
Practice Address - Street 2:UNIT A-
Practice Address - City:BUDD LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07828
Practice Address - Country:US
Practice Address - Phone:973-691-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01813300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist