MEDICARE: MRS. JOANNA WALCZAK AGAC-NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	26NJ01306800	NJ

General Provider Information

NPI Number	:	1740061308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOANNA WALCZAK AGAC-NP

Provider Business Mailing Address
First Line	:	222 NEW RD STE 201
Second Line	:
City	:	LINWOOD
State	:	NJ
Zip	:	08221-1281
Country	:	US
Telephone Number	:	609-788-8953
Fax Number	:	609-904-6929

Provider Business Practice Location Address
First Line	:	222 NEW RD STE 201
Second Line	:
City	:	LINWOOD
State	:	NJ
Zip	:	08221-1281
Country	:	US
Telephone Number	:	609-788-8953
Fax Number	:	609-904-6929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2023
Last Update Date	:	03/02/2026

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