Provider Demographics
NPI:1639233489
Name:JOSEPH J WALLIS & JOSEPH P MAUGERI
Entity Type:Organization
Organization Name:JOSEPH J WALLIS & JOSEPH P MAUGERI
Other - Org Name:TOWNSQUARE OB-GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-989-9000
Mailing Address - Street 1:600 MT PLEASANT AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-1630
Mailing Address - Country:US
Mailing Address - Phone:973-989-9000
Mailing Address - Fax:973-989-8225
Practice Address - Street 1:600 MT PLEASANT AVE
Practice Address - Street 2:SUITE G
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-1630
Practice Address - Country:US
Practice Address - Phone:973-989-9000
Practice Address - Fax:973-989-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02488400207V00000X
NJ25MA05912400207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD80324Medicare UPIN
NJ417962PW4Medicare ID - Type UnspecifiedMEDICARE
NJ151036PW4Medicare ID - Type UnspecifiedMEDICARE
NJF68657Medicare UPIN