MEDICARE: MR. JOSEPH DUCHAK JR. LPC

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	101YP2500X	Professional Counselor	37PC00808700	NJ

General Provider Information

NPI Number	:	1619667888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH DUCHAK JR. LPC

Provider Business Mailing Address
First Line	:	PO BOX 643
Second Line	:
City	:	ALLENWOOD
State	:	NJ
Zip	:	08720-0643
Country	:	US
Telephone Number	:	908-489-7527
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 JEAN MARIE CT
Second Line	:
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	08724-0907
Country	:	US
Telephone Number	:	908-489-7527
Fax Number	:

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

Provider Enumeration Date	:	05/11/2023
Last Update Date	:	05/11/2023

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