Provider Demographics
NPI:1811260268
Name:STARCZAK, COLLEEN CLAIRE (DPT)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:CLAIRE
Last Name:STARCZAK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 CHOPIN DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6202
Mailing Address - Country:US
Mailing Address - Phone:973-907-2585
Mailing Address - Fax:
Practice Address - Street 1:700C LAKE ST
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1372
Practice Address - Country:US
Practice Address - Phone:201-962-7454
Practice Address - Fax:201-962-7455
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01108900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ322497YQHWMedicare UPIN