Provider Demographics
NPI:1235977521
Name:ONGSIAKO, BRUCE (DPT)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:ONGSIAKO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 AMBERLY DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-2137
Mailing Address - Country:US
Mailing Address - Phone:908-839-2421
Mailing Address - Fax:
Practice Address - Street 1:3276 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859-1676
Practice Address - Country:US
Practice Address - Phone:732-283-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02263500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist