Provider Demographics
NPI:1841771094
Name:SCOMAK, JAMIE M (DPT)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:M
Last Name:SCOMAK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:M
Other - Last Name:BESANTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:167 ROUTE 37 W
Mailing Address - Street 2:STE 2
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8046
Mailing Address - Country:US
Mailing Address - Phone:732-506-3471
Mailing Address - Fax:
Practice Address - Street 1:167 ROUTE 37 W # 2
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8046
Practice Address - Country:US
Practice Address - Phone:732-508-9926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-26
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01362200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty