Provider Demographics
NPI:1508824897
Name:BRIGNOLA, JOSEPH J (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:BRIGNOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:181 FRANKLIN AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2900
Mailing Address - Country:US
Mailing Address - Phone:973-667-8117
Mailing Address - Fax:973-667-6642
Practice Address - Street 1:181 FRANKLIN AVE
Practice Address - Street 2:#204
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3820
Practice Address - Country:US
Practice Address - Phone:973-667-8117
Practice Address - Fax:973-667-6642
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07700400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0032280Medicaid
NJ0032280Medicaid
NJI03481Medicare UPIN