Individual
GARY J MASCILAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
540 LAFAYETTE RD ROUTE 15 SO, SUITE B, SPARTA, NJ 07871
(973) 940-8680
(973) 940-8634
Mailing address
21 LAFAYETTE RD, SUITE C, SPARTA, NJ 07871
(973) 729-0291
(973) 729-6710
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
38MC00455100
NJ
208100000X
Physical Medicine & Rehabilitation Physician
Primary
40QA00611400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8380406
—
NJ
Enumeration date
09/26/2005
Last updated
07/22/2010
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