Provider Demographics
NPI:1164443206
Name:JOSEPH J FALLON JR MD PA
Entity Type:Organization
Organization Name:JOSEPH J FALLON JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FALLON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:856-853-1288
Mailing Address - Street 1:603 N BROAD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1619
Mailing Address - Country:US
Mailing Address - Phone:856-853-1111
Mailing Address - Fax:856-853-1288
Practice Address - Street 1:603 N BROAD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1619
Practice Address - Country:US
Practice Address - Phone:856-853-1111
Practice Address - Fax:856-853-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
110012275OtherMEDICARE RAILROAD
NJ3301303Medicaid
460000828OtherMEDICARE RAILROAD