Provider Demographics
NPI:1851314439
Name:BOZEK, JOSEPH W JR (DPM)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:W
Last Name:BOZEK
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 COLLEGE AVE
Mailing Address - Street 2:PROF ARTS BUILDING
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2231
Mailing Address - Country:US
Mailing Address - Phone:724-774-1525
Mailing Address - Fax:724-774-0366
Practice Address - Street 1:336 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2231
Practice Address - Country:US
Practice Address - Phone:724-774-1525
Practice Address - Fax:724-774-0366
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002220L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA220084OtherHEALTH AMERICA
PA1006325Medicaid
PA220084OtherHEALTH ASSURANCE
PA000100812OtherBC & BS
PA000416855OtherKEYSTONE
PA100812Medicare PIN
PA000100812OtherBC & BS