Provider Demographics
NPI:1891781514
Name:CASELLA, JOSEPH J (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:CASELLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 LAFAYETTE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-4411
Mailing Address - Country:US
Mailing Address - Phone:973-940-0423
Mailing Address - Fax:973-940-0399
Practice Address - Street 1:272 US HIGHWAY 206
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:NJ
Practice Address - Zip Code:07821-3950
Practice Address - Country:US
Practice Address - Phone:973-347-2273
Practice Address - Fax:973-729-3238
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04068700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1572105Medicaid
NJCA452691Medicare ID - Type Unspecified
NJ1572105Medicaid