Provider Demographics
NPI:1710991187
Name:CERVONE, JOSEPH STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:STEPHEN
Last Name:CERVONE
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 1:85 S JEFFERSON ST
Mailing Address - Street 2:STE. 1
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-1562
Mailing Address - Country:US
Mailing Address - Phone:973-677-3466
Mailing Address - Fax:973-677-2362
Practice Address - Street 1:741 NORTHFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1174
Practice Address - Country:US
Practice Address - Phone:973-325-3606
Practice Address - Fax:973-736-8964
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04827100207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1K9722OtherHEALTHNET
NYJC08C45310OtherEMPIRE BCBS
NJ1056107Medicaid
NJ4827100OtherAETNA
NYJC08C45310OtherEMPIRE BCBS
D18630Medicare UPIN
NJ1056107Medicaid