Provider Demographics
NPI:1245362474
Name:FUNICIELLO, JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:FUNICIELLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20-24 BRANFORD PL
Mailing Address - Street 2:SUITE 805
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2786
Mailing Address - Country:US
Mailing Address - Phone:973-643-3234
Mailing Address - Fax:973-643-5428
Practice Address - Street 1:20-24 BRANFORD PL
Practice Address - Street 2:SUITE 805
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2786
Practice Address - Country:US
Practice Address - Phone:973-643-3234
Practice Address - Fax:973-643-5428
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor