Provider Demographics
NPI:1467453738
Name:MIKE, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MIKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 EVES DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3193
Mailing Address - Country:US
Mailing Address - Phone:856-669-6061
Mailing Address - Fax:856-651-0853
Practice Address - Street 1:17 W RED BANK AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1630
Practice Address - Country:US
Practice Address - Phone:856-848-8242
Practice Address - Fax:856-384-6015
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05623000208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5046505Medicaid
683291Medicare ID - Type Unspecified
E95238Medicare UPIN