Provider Demographics
NPI:1275759516
Name:ARDOLINO, JOSEPH MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:ARDOLINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010
Mailing Address - Country:US
Mailing Address - Phone:201-945-2390
Mailing Address - Fax:201-945-2390
Practice Address - Street 1:377 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PK
Practice Address - State:NJ
Practice Address - Zip Code:07010
Practice Address - Country:US
Practice Address - Phone:201-945-2390
Practice Address - Fax:201-945-2390
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA56772207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G62307Medicare UPIN
004404Medicare ID - Type Unspecified