Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 25MB10352600 | NJ |
NPI | 1003298662 |
---|---|
Provider Name | Dr. Joshua Mleczko |
First Address | Bordentown, NJ 08505-2275 |
Second Address | Bordentown, NJ 08505-2275 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2015 |
Last Update Date | 27/04/2021 |