Provider Demographics
NPI:1588786305
Name:PONZINI, PETER NICHOLAS (DC)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:NICHOLAS
Last Name:PONZINI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 E FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:HO HO KUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07423-1553
Mailing Address - Country:US
Mailing Address - Phone:201-447-0346
Mailing Address - Fax:201-447-1582
Practice Address - Street 1:197 E FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:HO HO KUS
Practice Address - State:NJ
Practice Address - Zip Code:07423-1553
Practice Address - Country:US
Practice Address - Phone:201-447-0346
Practice Address - Fax:201-447-1582
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00619200111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU99185Medicare UPIN