Healthcare Provider Details

I. General information

NPI: 1912796111
Provider Name (Legal Business Name): JOSEPH FARES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MULLICA HILL RD
MULLICA HILL NJ
08062-4413
US

IV. Provider business mailing address

2 MEADOW HILLS DR
SOMERSET NJ
08873-5332
US

V. Phone/Fax

Practice location:
  • Phone: 856-508-1000
  • Fax:
Mailing address:
  • Phone: 732-789-3929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: