Provider Demographics
NPI:1154399731
Name:BOLINSKY, JOSEPH JOHN III (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:JOHN
Last Name:BOLINSKY
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201A N CHURCH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HAZLE TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18202-1471
Mailing Address - Country:US
Mailing Address - Phone:570-455-8544
Mailing Address - Fax:
Practice Address - Street 1:1201A N CHURCH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202-1471
Practice Address - Country:US
Practice Address - Phone:570-455-8544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA001001363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50050251OtherCBC
PAP00381588OtherMEDICARE RAILROAD
PA085967QJGMedicare ID - Type Unspecified
PA50050251OtherCBC