Provider Demographics
NPI:1679597249
Name:JOSEPH, JAY PHILIP (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:PHILIP
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:992 MANTUA PIKE STE 304
Mailing Address - Street 2:
Mailing Address - City:WOODBURY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08097-1249
Mailing Address - Country:US
Mailing Address - Phone:856-853-8900
Mailing Address - Fax:856-853-0268
Practice Address - Street 1:992 MANTUA PIKE STE 304
Practice Address - Street 2:
Practice Address - City:WOODBURY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08097-1249
Practice Address - Country:US
Practice Address - Phone:856-853-8900
Practice Address - Fax:856-853-0268
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI010575001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice