Basic Information
Provider Information
NPI: 1003298662
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MLECZKO
FirstName: JOSHUA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 3RD ST
Address2:  
City: BORDENTOWN
State: NJ
PostalCode: 085051321
CountryCode: US
TelephoneNumber: 6092982005
FaxNumber: 6093248267
Practice Location
Address1: 1 3RD ST
Address2:  
City: BORDENTOWN
State: NJ
PostalCode: 08505
CountryCode: US
TelephoneNumber: 6092982005
FaxNumber: 6093248267
Other Information
ProviderEnumerationDate: 06/19/2015
LastUpdateDate: 05/25/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X25MB10352600NJY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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