Provider Demographics
NPI:1578849345
Name:JOSEPH, MONALISA (MD)
Entity Type:Individual
Prefix:DR
First Name:MONALISA
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 HAMBURG TPKE
Mailing Address - Street 2:SUITE# 201
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2162
Mailing Address - Country:US
Mailing Address - Phone:973-389-1119
Mailing Address - Fax:
Practice Address - Street 1:342 HAMBURG TPKE
Practice Address - Street 2:SUITE# 201
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2162
Practice Address - Country:US
Practice Address - Phone:973-389-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263280207R00000X
NJ25MA09434800207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine