Provider Demographics
NPI:1477567980
Name:MICHEL, JOSEPH R (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:MICHEL
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:WESTWOOD PROFESSIONAL BLDG.
Mailing Address - Street 2:297 WESTWOOD DR. SUITE 104
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096
Mailing Address - Country:US
Mailing Address - Phone:856-848-1083
Mailing Address - Fax:856-848-2271
Practice Address - Street 1:WESTWOOD PROFESSIONAL BLDG.
Practice Address - Street 2:297 WESTWOOD DR. SUITE 104
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096
Practice Address - Country:US
Practice Address - Phone:856-848-1083
Practice Address - Fax:856-848-2271
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03374600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0873705Medicaid
NJ0097847001OtherBLUE CROSS, AMERIHEALTH
NJ60001921OtherHORIZON NJ HEALTH
NJ222287308OtherTAX ID
D06338Medicare UPIN
NJ404574Medicare ID - Type Unspecified