Provider Demographics
NPI:1972013209
Name:JOSEPH, SHOBHANA R (RN, MSN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHOBHANA
Middle Name:R
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:RN, MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 ESSEX ST STE 303
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-8566
Mailing Address - Country:US
Mailing Address - Phone:551-996-8100
Mailing Address - Fax:551-996-4140
Practice Address - Street 1:360 ESSEX ST STE 303
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:551-996-8100
Practice Address - Fax:551-996-4140
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00747900363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty