Provider Demographics
NPI:1700061744
Name:VARA MASUR, MARYBETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARYBETH
Middle Name:
Last Name:VARA MASUR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MADISON AVE STE 109A
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7331
Mailing Address - Country:US
Mailing Address - Phone:908-852-7575
Mailing Address - Fax:908-852-7575
Practice Address - Street 1:95 MADISON AVE STE 109A
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7331
Practice Address - Country:US
Practice Address - Phone:908-852-7575
Practice Address - Fax:908-852-7575
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00337000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA00337000OtherPHYSICAL THERAPY