Provider Demographics
NPI:1902027345
Name:PROKOP, ANDREW G III (BS, MSPT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:G
Last Name:PROKOP
Suffix:III
Gender:M
Credentials:BS, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BISCAYNE RD
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-2616
Mailing Address - Country:US
Mailing Address - Phone:732-330-6954
Mailing Address - Fax:
Practice Address - Street 1:215 BISCAYNE RD
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-2616
Practice Address - Country:US
Practice Address - Phone:732-330-6954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00681000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist