Provider Demographics
NPI:1093721292
Name:LIOTTI, JOSEPH BRIAN (DO, FAOASM)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BRIAN
Last Name:LIOTTI
Suffix:
Gender:M
Credentials:DO, FAOASM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SAND RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-1571
Mailing Address - Country:US
Mailing Address - Phone:973-808-9242
Mailing Address - Fax:973-244-0585
Practice Address - Street 1:125 SAND RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-1571
Practice Address - Country:US
Practice Address - Phone:973-808-9242
Practice Address - Fax:973-244-0585
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB050538207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE79079Medicare UPIN