Provider Demographics
NPI:1932935129
Name:MASCENIK, SAMANTHA E (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:E
Last Name:MASCENIK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 TABOR RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-2734
Mailing Address - Country:US
Mailing Address - Phone:973-829-0200
Mailing Address - Fax:973-829-0500
Practice Address - Street 1:968 TABOR RD
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-2734
Practice Address - Country:US
Practice Address - Phone:973-829-0200
Practice Address - Fax:973-829-0500
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02281100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty