Provider Demographics
NPI:1689185431
Name:SCHMARAK, JUSTIN (ATC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:SCHMARAK
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-1402
Mailing Address - Country:US
Mailing Address - Phone:201-288-6150
Mailing Address - Fax:
Practice Address - Street 1:365 BOULEVARD
Practice Address - Street 2:
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604-1402
Practice Address - Country:US
Practice Address - Phone:201-288-6150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJBOC1886012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer