Provider Demographics
NPI:1902836430
Name:BEDNAR, JOSEPH F (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:F
Last Name:BEDNAR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-1306
Mailing Address - Country:US
Mailing Address - Phone:201-529-9330
Mailing Address - Fax:201-529-9331
Practice Address - Street 1:180 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-1306
Practice Address - Country:US
Practice Address - Phone:201-529-9330
Practice Address - Fax:201-529-9331
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00240000111N00000X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1836501Medicaid
NJT45415Medicare UPIN
NJ454658Medicare PIN