Provider Demographics
NPI:1649269028
Name:MISDRAJI, JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:MISDRAJI
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 1:310 CEDAR STREET
Mailing Address - Street 2:YSM, BRADY MEMORIAL LABORATORY
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520
Mailing Address - Country:US
Mailing Address - Phone:203-785-3624
Mailing Address - Fax:
Practice Address - Street 1:310 CEDAR STREET
Practice Address - Street 2:YSM, BRADY MEMORIAL LABORATORY
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520
Practice Address - Country:US
Practice Address - Phone:203-785-3624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153609207ZC0500X
CT69135207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3166112Medicaid
MAG44125Medicare UPIN
MAA22287Medicare ID - Type Unspecified