Provider Demographics
NPI:1023827755
Name:TAKACH, MARK STEPHEN
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEPHEN
Last Name:TAKACH
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 1:27-16 KIPP ST
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3249
Mailing Address - Country:US
Mailing Address - Phone:551-206-3941
Mailing Address - Fax:
Practice Address - Street 1:66 N RTE 17 STE 900
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2749
Practice Address - Country:US
Practice Address - Phone:201-368-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant