Provider Demographics
NPI:1134755861
Name:JOSCAK, TERI JULIA
Entity type:Individual
Prefix:MRS
First Name:TERI
Middle Name:JULIA
Last Name:JOSCAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH VERSAILLES
Mailing Address - State:PA
Mailing Address - Zip Code:15137-1914
Mailing Address - Country:US
Mailing Address - Phone:412-398-4317
Mailing Address - Fax:
Practice Address - Street 1:515 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:NORTH VERSAILLES
Practice Address - State:PA
Practice Address - Zip Code:15137-1914
Practice Address - Country:US
Practice Address - Phone:412-398-4317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10974175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist