Provider Demographics
NPI:1598789273
Name:BONCZEK, JOSEPH V (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:V
Last Name:BONCZEK
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 1:67 HIGBEE AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2323
Mailing Address - Country:US
Mailing Address - Phone:609-204-4849
Mailing Address - Fax:609-653-1258
Practice Address - Street 1:67 HIGBEE AVE
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2323
Practice Address - Country:US
Practice Address - Phone:609-204-4849
Practice Address - Fax:609-653-1258
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00748400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ066929Medicare ID - Type UnspecifiedMEDICARE BILLING PROVIDER