Provider Demographics
NPI:1588601462
Name:JODAR, JOANNA (CA)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:JODAR
Suffix:
Gender:F
Credentials:CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1975
Mailing Address - Country:US
Mailing Address - Phone:732-545-3800
Mailing Address - Fax:732-545-3801
Practice Address - Street 1:636 EASTON AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1975
Practice Address - Country:US
Practice Address - Phone:732-545-3800
Practice Address - Fax:732-545-3801
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist