Provider Demographics
NPI:1912054420
Name:ACQUAVIVA, JOSEPH F (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:ACQUAVIVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:205 CARMAL CT
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-2164
Mailing Address - Country:US
Mailing Address - Phone:201-891-9059
Mailing Address - Fax:201-488-6916
Practice Address - Street 1:140 PROSPECT AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2255
Practice Address - Country:US
Practice Address - Phone:201-488-6543
Practice Address - Fax:201-488-6916
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ507252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56877Medicare UPIN