Provider Demographics
NPI:1083821615
Name:SAGCAL, JOSEPH PONCE (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:PONCE
Last Name:SAGCAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 COOLIDGE AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2853
Mailing Address - Country:US
Mailing Address - Phone:732-331-5450
Mailing Address - Fax:
Practice Address - Street 1:17 COOLIDGE AVE
Practice Address - Street 2:APT. 1
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2853
Practice Address - Country:US
Practice Address - Phone:732-331-5450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40PTQA00757100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist