Provider Demographics
NPI:1912487679
Name:YANOSH, RACHEL MARA (MS, LAT, ATC, EMT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARA
Last Name:YANOSH
Suffix:
Gender:F
Credentials:MS, LAT, ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-1805
Mailing Address - Country:US
Mailing Address - Phone:973-271-4270
Mailing Address - Fax:
Practice Address - Street 1:42 WARREN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1805
Practice Address - Country:US
Practice Address - Phone:973-271-4270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002059002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer