Healthcare Provider Details

I. General information

NPI: 1356409932
Provider Name (Legal Business Name): JAMES F BONCZEK LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E 28TH ST 315
NEW YORK NY
10016-8413
US

IV. Provider business mailing address

6 STUYVESANT OVAL #8H
NEW YORK NY
10009-2412
US

V. Phone/Fax

Practice location:
  • Phone: 917-449-6296
  • Fax:
Mailing address:
  • Phone: 212-982-1218
  • Fax: 212-217-9126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberR0308131
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: