Healthcare Provider Details

I. General information

NPI: 1295723807
Provider Name (Legal Business Name): JOSEPH ANTHONY JASKOLSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 COUNTY ROAD 513
CALIFON NJ
07830-4158
US

IV. Provider business mailing address

384 COUNTY ROAD 513
CALIFON NJ
07830-4158
US

V. Phone/Fax

Practice location:
  • Phone: 908-832-2125
  • Fax: 908-832-6149
Mailing address:
  • Phone: 908-832-2125
  • Fax: 908-832-6149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA067477
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: