Individual
JENNIFER L. BONCZEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
26 CITY HALL MALL, MEDFORD, MA 02155-4754
(617) 629-6444
Mailing address
26 CITY HALL MALL, MEDFORD, MA 02155-4754
(781) 306-5190
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2385
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0037904
NEIGHBORHOOD HEALTH PLAN
MA
01
—
680078
TUFTS HEALTH PLAN
MA
01
—
AA59315
HARVARD PILGRIM
MA
Enumeration date
05/16/2006
Last updated
09/28/2009
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