Provider Demographics
NPI:1750354197
Name:JOSEPH SIGNORILE PC
Entity type:Organization
Organization Name:JOSEPH SIGNORILE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SELF PROPRIETER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGNORILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-755-4200
Mailing Address - Street 1:12 FOX HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4765
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:908 OAK TREE AVE
Practice Address - Street 2:SUITE O
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080
Practice Address - Country:US
Practice Address - Phone:908-755-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD00271500213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU85943Medicare UPIN
NJ4581680001Medicare NSC