Healthcare Provider Details

I. General information

NPI: 1922919562
Provider Name (Legal Business Name): DEREK P SZUBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 RIVER ST
HACKENSACK NJ
07601-7514
US

IV. Provider business mailing address

576 BROADHOLLOW RD
MELVILLE NY
11747-5012
US

V. Phone/Fax

Practice location:
  • Phone: 201-992-0178
  • Fax:
Mailing address:
  • Phone: 631-359-5859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02450100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: