Active NPI
Jennifer L. Bonczek, RD
- Registered Dietitian
- Medford, MA
National Provider Identifier
1578515169
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2385
- Practice address
- 26 City Hall Mall
Medford, MA 02155-4754 - Phone
- (617) 629-6444
- NPI assigned
- May 16, 2006
- Last updated
- Sep 28, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 2385 | MA | Primary |
Addresses
Primary practice location
26 City Hall Mall
Medford, MA 02155-4754
Mailing address
26 City Hall Mall
Medford, MA 02155-4754
Phone (781) 306-5190
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 680078 | Other | MA | TUFTS HEALTH PLAN |
| 0037904 | Other | MA | NEIGHBORHOOD HEALTH PLAN |
| AA59315 | Other | MA | HARVARD PILGRIM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2385 | MA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254096000000",
"number": "1578515169",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26 CITY HALL MALL",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021554754",
"telephone_number": "781-306-5190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26 CITY HALL MALL",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021554754",
"telephone_number": "617-629-6444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONCZEK",
"first_name": "JENNIFER",
"middle_name": "L.",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-16",
"last_updated": "2009-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MA",
"license": "2385",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLAN",
"identifier": "680078",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEIGHBORHOOD HEALTH PLAN",
"identifier": "0037904",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "AA59315",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.