Provider Demographics
NPI:1518051499
Name:JOSEPH, ALBERT M (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:M
Last Name:JOSEPH
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 1:22-18 BROADWAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3016
Mailing Address - Country:US
Mailing Address - Phone:973-256-5557
Mailing Address - Fax:973-256-5036
Practice Address - Street 1:22-18 BROADWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3016
Practice Address - Country:US
Practice Address - Phone:973-256-5557
Practice Address - Fax:973-256-5036
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA49616208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
F39790Medicare UPIN
NJ002271Medicare ID - Type Unspecified