Provider Demographics
NPI:1225413651
Name:PODESZWA, JEFF DOUGLAS (BS, ATC)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:DOUGLAS
Last Name:PODESZWA
Suffix:
Gender:M
Credentials:BS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MANSION HILL DR
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-2656
Mailing Address - Country:US
Mailing Address - Phone:609-613-1158
Mailing Address - Fax:
Practice Address - Street 1:18 MANSION HILL DR
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-2656
Practice Address - Country:US
Practice Address - Phone:609-613-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer