Provider Demographics
NPI:1356941686
Name:DESIMONE, JOSEPH J (HIS)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:DESIMONE
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 MARLTON PIKE W
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002
Mailing Address - Country:US
Mailing Address - Phone:856-471-7870
Mailing Address - Fax:856-665-6813
Practice Address - Street 1:14 FOXHUNT DR
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-2534
Practice Address - Country:US
Practice Address - Phone:410-392-2797
Practice Address - Fax:856-665-6813
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO3-0000131237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEO3-000131OtherSTATE OF DELAWARE DIV OF PROFESSIONAL REGULATION