Provider Demographics
NPI:1548994437
Name:JOSEPH, MARY BRINDA JOSE
Entity type:Individual
Prefix:DR
First Name:MARY BRINDA
Middle Name:JOSE
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 ELLSWORTH WAY
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-2046
Mailing Address - Country:US
Mailing Address - Phone:201-208-9151
Mailing Address - Fax:
Practice Address - Street 1:731 ROUTE 33
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-4418
Practice Address - Country:US
Practice Address - Phone:201-208-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02915100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist