Provider Demographics
NPI:1457602559
Name:SZUBIAK, MARY (LAC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SZUBIAK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 NEWARK ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4548
Mailing Address - Country:US
Mailing Address - Phone:201-653-7700
Mailing Address - Fax:201-604-6382
Practice Address - Street 1:51 NEWARK ST
Practice Address - Street 2:SUITE 403
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4548
Practice Address - Country:US
Practice Address - Phone:201-653-7700
Practice Address - Fax:201-604-6382
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00086400171100000X
NY0046941171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist