Provider Demographics
NPI:1881984508
Name:DR JOSEPH W BOZEK JR PC
Entity type:Organization
Organization Name:DR JOSEPH W BOZEK JR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOZEK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:724-774-1525
Mailing Address - Street 1:336 COLLEGE AVE
Mailing Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002220L261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100812Medicare UPIN