Provider Demographics
NPI:1194841064
Name:PAPA, JOSEPH L (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:PAPA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3624
Mailing Address - Country:US
Mailing Address - Phone:732-549-3330
Mailing Address - Fax:732-738-6006
Practice Address - Street 1:940 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2811
Practice Address - Country:US
Practice Address - Phone:732-738-1904
Practice Address - Fax:732-738-6006
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2653152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ521744Medicare PIN