Healthcare Provider Details

I. General information

NPI: 1861501066
Provider Name (Legal Business Name): JOAQUIM J. CORREIA, MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 CHESTNUT ST STE 2L
NEWARK NJ
07105-6501
US

IV. Provider business mailing address

140 W END PL
CRANFORD NJ
07016-1720
US

V. Phone/Fax

Practice location:
  • Phone: 973-589-8668
  • Fax: 973-589-7996
Mailing address:
  • Phone: 908-931-0730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA05045300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number25MA05045300
License Number StateNJ

VIII. Authorized Official

Name: DR. JOAQUIM J CORREIA
Title or Position: PRESIDENT
Credential: MD
Phone: 973-589-8668