Provider Demographics
NPI:1649303702
Name:JOSEPH A MAURIELLO JR MD
Entity type:Organization
Organization Name:JOSEPH A MAURIELLO JR MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAURIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-530-0010
Mailing Address - Street 1:130 MAPLE AVE
Mailing Address - Street 2:SUITE 9 B-2
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1749
Mailing Address - Country:US
Mailing Address - Phone:732-530-0010
Mailing Address - Fax:732-530-0029
Practice Address - Street 1:130 MAPLE AVE.
Practice Address - Street 2:SUITE 9 B-2
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1749
Practice Address - Country:US
Practice Address - Phone:732-530-0010
Practice Address - Fax:732-530-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03340200207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ454029Medicare ID - Type UnspecifiedNORTH JERSEY
NJ065708Medicare ID - Type UnspecifiedSOUTH JERSEY