Provider Demographics
NPI:1487030243
Name:IONESCU, BOGDAN
Entity Type:Individual
Prefix:
First Name:BOGDAN
Middle Name:
Last Name:IONESCU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 NEWARK POMPTON TPKE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-1112
Mailing Address - Country:US
Mailing Address - Phone:877-887-3574
Mailing Address - Fax:862-279-7580
Practice Address - Street 1:188 NEWARK POMPTON TPKE
Practice Address - Street 2:UNIT 1
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-1112
Practice Address - Country:US
Practice Address - Phone:877-887-3574
Practice Address - Fax:862-279-7580
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00657000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist