Provider Demographics
NPI:1164400313
Name:VARALLO, JOSEPH ANTHONY (MD LLC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:VARALLO
Suffix:
Gender:M
Credentials:MD LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 CENTRAL AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-0000
Mailing Address - Country:US
Mailing Address - Phone:609-601-2800
Mailing Address - Fax:609-601-2282
Practice Address - Street 1:303 CENTRAL AVE
Practice Address - Street 2:STE 2
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-8353
Practice Address - Country:US
Practice Address - Phone:609-601-2800
Practice Address - Fax:609-601-2282
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA19413207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC53452Medicare UPIN
NJ132543RK4Medicare PIN