Provider Demographics
NPI:1760146633
Name:POMALES, JOEL SCOTT (CPRS)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:SCOTT
Last Name:POMALES
Suffix:
Gender:M
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2958
Mailing Address - Country:US
Mailing Address - Phone:732-887-7256
Mailing Address - Fax:732-659-9394
Practice Address - Street 1:500 CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2958
Practice Address - Country:US
Practice Address - Phone:732-887-7256
Practice Address - Fax:732-659-9394
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty