Provider Demographics
NPI:1780865451
Name:JOSEPH VARALLO MD LLC
Entity Type:Organization
Organization Name:JOSEPH VARALLO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VARALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD LLC
Authorized Official - Phone:609-601-2800
Mailing Address - Street 1:303 CENTRAL AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:EGG HBR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-8353
Mailing Address - Country:US
Mailing Address - Phone:609-601-2800
Mailing Address - Fax:
Practice Address - Street 1:303 CENTRAL AVE
Practice Address - Street 2:STE 2
Practice Address - City:EGG HBR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08234-8353
Practice Address - Country:US
Practice Address - Phone:609-601-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA019413207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID
NJ=========OtherTAX ID
NJC53452Medicare UPIN