Healthcare Provider Details

I. General information

NPI: 1215266580
Provider Name (Legal Business Name): JOSEPH S ONGOCO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 FORD RD
PHILADELPHIA PA
19131-2833
US

IV. Provider business mailing address

1953 ALAMINGO DR
QUAKERTOWN PA
18951-3206
US

V. Phone/Fax

Practice location:
  • Phone: 317-388-0800
  • Fax: 317-388-0805
Mailing address:
  • Phone: 317-796-0800
  • Fax: 317-796-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number031259-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT020474
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: