Provider Demographics
NPI:1720025059
Name:HALEY, JOSEPH PATRICK (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PATRICK
Last Name:HALEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 NORTH BLACK HORSE PIKE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-1043
Mailing Address - Country:US
Mailing Address - Phone:856-629-7518
Mailing Address - Fax:856-629-1838
Practice Address - Street 1:1035 NORTH BLACK HORSE PIKE
Practice Address - Street 2:UNIT 1
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-1043
Practice Address - Country:US
Practice Address - Phone:856-629-7518
Practice Address - Fax:856-629-1838
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00241700213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8407606Medicaid
NJ4480790001Medicare NSC
NJU60792Medicare UPIN
NJ8407606Medicaid