Provider Demographics
NPI:1558462556
Name:JOSEPH, ERIC MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MARK
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1500 PLEASANT VALLEY WAY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052
Mailing Address - Country:US
Mailing Address - Phone:973-325-1155
Mailing Address - Fax:973-325-8668
Practice Address - Street 1:1500 PLEASANT VALLEY WAY
Practice Address - Street 2:SUITE 206
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052
Practice Address - Country:US
Practice Address - Phone:973-325-1155
Practice Address - Fax:973-325-8668
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA067103207YS0123X
NY2019411207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8442606Medicaid
G97215Medicare UPIN
NJ026379Medicare ID - Type Unspecified