Provider Demographics
NPI:1861501066
Name:JOAQUIM J. CORREIA, MD LLC
Entity Type:Organization
Organization Name:JOAQUIM J. CORREIA, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAQUIM
Authorized Official - Middle Name:J
Authorized Official - Last Name:CORREIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-589-8668
Mailing Address - Street 1:140 W END PL
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-1720
Mailing Address - Country:US
Mailing Address - Phone:908-931-0730
Mailing Address - Fax:
Practice Address - Street 1:243 CHESTNUT ST STE 2L
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-6501
Practice Address - Country:US
Practice Address - Phone:973-589-8668
Practice Address - Fax:973-589-7996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05045300207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6144306Medicaid
2645610Medicare UPIN
P2543415Medicare UPIN
P00091112Medicare UPIN
NJ6144306Medicaid
NJ413905Medicare PIN