Provider Demographics
NPI:1497208003
Name:BELLOMO, JOSEPH JACK (MSOTR)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:JACK
Last Name:BELLOMO
Suffix:
Gender:M
Credentials:MSOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 SCHWINN DR
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-2724
Mailing Address - Country:US
Mailing Address - Phone:908-472-5419
Mailing Address - Fax:
Practice Address - Street 1:95 SCHWINN DR
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-2724
Practice Address - Country:US
Practice Address - Phone:908-472-5419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-31
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00561700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist