Basic Information
| Provider Information | |||||||||
| NPI: | 1659991388 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STASAK | ||||||||
| FirstName: | JOELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 GARDEN ST APT 3 | ||||||||
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| City: | HOBOKEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070303701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4847677625 | ||||||||
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| Practice Location | |||||||||
| Address1: | 178 OGDEN AVE | ||||||||
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| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073071337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019631800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2020 | ||||||||
| LastUpdateDate: | 04/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 46TR00823700 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.