Provider Demographics
NPI:1205945623
Name:CORREIA, JOAQUIM JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:JOAQUIM
Middle Name:JOSE
Last Name:CORREIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:908-589-7996
Is Sole Proprietor?:Yes
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?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ413905Medicaid
2K3387Medicare UPIN
P2543415Medicare UPIN
NJ413905Medicare PIN
NJ413905Medicaid
2645610Medicare UPIN