Provider Demographics
NPI:1225070741
Name:HEJDUK, JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:HEJDUK
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 1:1812 MARSH RD
Mailing Address - Street 2:STORE 505
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4581
Mailing Address - Country:US
Mailing Address - Phone:302-793-1800
Mailing Address - Fax:302-793-0800
Practice Address - Street 1:4 N PARKE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2436
Practice Address - Country:US
Practice Address - Phone:410-297-8141
Practice Address - Fax:410-297-8142
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
64518701OtherNCA
2862793000OtherAMERIHEALTH IBC
MD35034136OtherCAREFIRST
5070-0030OtherCARE FIRST
5070-0030OtherCARE FIRST
MD306PR234Medicare PIN
MD313PP357Medicare PIN
64518701OtherNCA
$$$$$$$$$OtherCHAMPUS