Provider Demographics
NPI:1467869727
Name:JOSEPH, JERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 FRANKLIN LAKE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-2267
Mailing Address - Country:US
Mailing Address - Phone:201-904-2230
Mailing Address - Fax:201-904-2232
Practice Address - Street 1:851 FRANKLIN LAKE RD STE 105
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417
Practice Address - Country:US
Practice Address - Phone:201-904-2230
Practice Address - Fax:201-904-2232
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2872312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP26A34096-10147OtherGHI
NJ25MA10139400OtherSTATE LICENSE