Provider Demographics
NPI:1104860170
Name:JOSEPH, VALSAMMA (ANP-C)
Entity Type:Individual
Prefix:MRS
First Name:VALSAMMA
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:VALSAMMA
Other - Middle Name:
Other - Last Name:MATHAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 MAY ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3266
Mailing Address - Country:US
Mailing Address - Phone:732-738-8855
Mailing Address - Fax:732-738-4141
Practice Address - Street 1:225 MAY ST
Practice Address - Street 2:SUITE F
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3266
Practice Address - Country:US
Practice Address - Phone:732-738-8855
Practice Address - Fax:732-738-4141
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00074000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0061735Medicaid
NJ094929AIVMedicare ID - Type UnspecifiedMEDICARE #
NJ0061735Medicaid