Healthcare Provider Details

I. General information

NPI: 1003114026
Provider Name (Legal Business Name): JACOB R SCHUCK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 BROAD ST STE 250
BLOOMFIELD NJ
07003-3066
US

IV. Provider business mailing address

1455 BROAD ST STE 250
BLOOMFIELD NJ
07003-3066
US

V. Phone/Fax

Practice location:
  • Phone: 732-719-7168
  • Fax:
Mailing address:
  • Phone: 877-532-7837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01371700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: