Provider Demographics
NPI:1578963690
Name:HORBATUCK, ERIC T (PTA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:T
Last Name:HORBATUCK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 WYCKOFF AVE
Mailing Address - Street 2:UNIT 1 NW
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-3186
Mailing Address - Country:US
Mailing Address - Phone:201-904-2051
Mailing Address - Fax:201-904-2054
Practice Address - Street 1:860 WYCKOFF AVE
Practice Address - Street 2:UNIT 1 NW
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-3186
Practice Address - Country:US
Practice Address - Phone:201-904-2051
Practice Address - Fax:201-904-2054
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00298100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant