Provider Demographics
NPI:1952442212
Name:HOLASEK, JONATHAN W (DAC, CA, L AC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:W
Last Name:HOLASEK
Suffix:
Gender:M
Credentials:DAC, CA, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LAUREL HILL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1109
Mailing Address - Country:US
Mailing Address - Phone:973-334-0344
Mailing Address - Fax:
Practice Address - Street 1:115 US HIGHWAY 46
Practice Address - Street 2:SUITE A3
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1668
Practice Address - Country:US
Practice Address - Phone:973-331-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00044600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist