Provider Demographics
NPI:1639432602
Name:JOSEPH, JOANNE IRIS (MS ED)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:IRIS
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CONGER ST
Mailing Address - Street 2:APT. 304B
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3370
Mailing Address - Country:US
Mailing Address - Phone:347-232-8636
Mailing Address - Fax:
Practice Address - Street 1:40 CONGER ST
Practice Address - Street 2:APT. 304B
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3370
Practice Address - Country:US
Practice Address - Phone:347-232-8636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-24
Last Update Date:2012-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2134863174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist