Provider Demographics
NPI:1417085937
Name:JOSEPH, LISA VETTEMVELY (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:VETTEMVELY
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:7 ROSEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-3801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:477 ROUTE 10 E
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2142
Practice Address - Country:US
Practice Address - Phone:862-260-3020
Practice Address - Fax:973-328-6869
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY253343207R00000X
NJMA067076207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ027605Medicare ID - Type Unspecified
NJG94371Medicare UPIN