Provider Demographics
NPI:1982013033
Name:SCHRACK, CONNOR SCOTT
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:SCOTT
Last Name:SCHRACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-1509
Mailing Address - Country:US
Mailing Address - Phone:973-997-6345
Mailing Address - Fax:
Practice Address - Street 1:144 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-1509
Practice Address - Country:US
Practice Address - Phone:973-997-6345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-03
Last Update Date:2014-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer