Susan H Penczak, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

38MC00554100 Issued in NJ

Practice address

2041 State Route 35
Wall Township, NJ 07719-3539

Phone

(732) 974-7022

Fax

(732) 974-7023

NPI assigned

Jul 5, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Specialty

Chiropractic

Education

New York Chiropractic College, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Penczak Family Chiropractic, LLC

  • Chiropractor
  • Wall, NJ
  • NPI 1083773923
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202428800000",
    "number": "1477584100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2041 STATE ROUTE 35",
            "city": "WALL TOWNSHIP",
            "state": "NJ",
            "postal_code": "077193539",
            "telephone_number": "732-974-7022",
            "fax_number": "732-974-7023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2041 STATE ROUTE 35",
            "city": "WALL TOWNSHIP",
            "state": "NJ",
            "postal_code": "077193539",
            "telephone_number": "732-974-7022",
            "fax_number": "732-974-7023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENCZAK",
        "first_name": "SUSAN",
        "middle_name": "H",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-05",
        "last_updated": "2008-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NJ",
            "license": "38MC00554100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH PRACTIC HMO I",
            "identifier": "2281138000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH INDIV. HMO ID",
            "identifier": "2273901000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P3271421",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Wall Township, NJ
• Providers in Wall Township, NJ by specialty
• Chiropractor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.