Provider Demographics
NPI:1568678100
Name:LAURELLI, JOSEPH PETER (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PETER
Last Name:LAURELLI
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 1:54 NATHAN DR
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2790
Mailing Address - Country:US
Mailing Address - Phone:973-596-2850
Mailing Address - Fax:
Practice Address - Street 1:54 NATHAN DR
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2790
Practice Address - Country:US
Practice Address - Phone:973-596-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA029536002084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ000720011NDAMedicaid
NJ000720011NDAMedicaid