Provider Demographics
NPI:1033341581
Name:MOCZERNIUK, JAROSLAW (DPT)
Entity Type:Individual
Prefix:
First Name:JAROSLAW
Middle Name:
Last Name:MOCZERNIUK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CRAIG RD
Mailing Address - Street 2:STE 108
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8731
Mailing Address - Country:US
Mailing Address - Phone:732-462-2162
Mailing Address - Fax:732-462-2137
Practice Address - Street 1:100 CRAIG RD
Practice Address - Street 2:STE 108
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8731
Practice Address - Country:US
Practice Address - Phone:732-462-2162
Practice Address - Fax:732-462-2137
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01323400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ166783OtherMEDICARE PTAN