Provider Demographics
NPI:1548484033
Name:JOSEPH, JENNIFER MARY (PA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARY
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:7 LOESER AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3000
Mailing Address - Country:US
Mailing Address - Phone:908-393-4051
Mailing Address - Fax:732-235-4820
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:973-971-5134
Practice Address - Fax:973-290-7060
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2009-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00155400363AS0400X
IL085-001212363AS0400X
NY011342-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILS38440Medicare UPIN
IL204226Medicare PIN