Provider Demographics
NPI:1356400717
Name:CHODAK, JOANNE (RNFA)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:
Last Name:CHODAK
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1958
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-1958
Mailing Address - Country:US
Mailing Address - Phone:732-552-9856
Mailing Address - Fax:732-286-4480
Practice Address - Street 1:112 GARY ROAD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-0248
Practice Address - Country:US
Practice Address - Phone:732-552-9856
Practice Address - Fax:732-286-4480
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO10709900163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant