Provider Demographics
NPI:1952465163
Name:JOSEPH, EDDY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:EDDY
Middle Name:MICHAEL
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDDIE
Other - Middle Name:MICHAEL
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1019 E JERSEY ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2510
Mailing Address - Country:US
Mailing Address - Phone:908-353-1171
Mailing Address - Fax:908-353-4660
Practice Address - Street 1:1019 E JERSEY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2510
Practice Address - Country:US
Practice Address - Phone:908-353-1171
Practice Address - Fax:908-353-4660
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA053693174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE53187Medicare UPIN