Provider Demographics
NPI:1609298082
Name:STAVITZ, JAMES (MS, ATC/LAT, FMSC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:STAVITZ
Suffix:
Gender:M
Credentials:MS, ATC/LAT, FMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-5220
Mailing Address - Country:US
Mailing Address - Phone:848-448-6045
Mailing Address - Fax:
Practice Address - Street 1:1121 SIERRA DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-5220
Practice Address - Country:US
Practice Address - Phone:848-448-6045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001905002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer