Provider Demographics
NPI:1851540124
Name:JOSEPH POTOSKY OD
Entity Type:Organization
Organization Name:JOSEPH POTOSKY OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:PTOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-935-0184
Mailing Address - Street 1:93 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-1910
Mailing Address - Country:US
Mailing Address - Phone:856-935-0184
Mailing Address - Fax:
Practice Address - Street 1:93 MARKET ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-1910
Practice Address - Country:US
Practice Address - Phone:856-935-0184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH POTOSKY OD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00422101152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0388680001Medicare NSC