Provider Demographics
NPI:1962565648
Name:ATZMON, JACK A
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:A
Last Name:ATZMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457-1127
Mailing Address - Country:US
Mailing Address - Phone:973-874-9777
Mailing Address - Fax:973-341-7791
Practice Address - Street 1:47 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1127
Practice Address - Country:US
Practice Address - Phone:973-874-7777
Practice Address - Fax:973-341-7791
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2024-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00705700111N00000X
NYX007493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX62332Medicare PIN