Provider Demographics
NPI:1093875015
Name:FOSSATI, JEFFREY JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOSEPH
Last Name:FOSSATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:37 W CENTURY RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1409
Mailing Address - Country:US
Mailing Address - Phone:201-262-2244
Mailing Address - Fax:201-262-2246
Practice Address - Street 1:37 W CENTURY RD
Practice Address - Street 2:SUITE 111
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1409
Practice Address - Country:US
Practice Address - Phone:201-262-2244
Practice Address - Fax:201-262-2246
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA061133208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ228059Medicare PIN