Healthcare Provider Details

I. General information

NPI: 1154807303
Provider Name (Legal Business Name): NATALIE JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 BROADWAY
NEWARK NJ
07104-4309
US

IV. Provider business mailing address

26 VAN WINKLE ST APT D
BLOOMFIELD NJ
07003-6282
US

V. Phone/Fax

Practice location:
  • Phone: 973-483-1300
  • Fax:
Mailing address:
  • Phone: 862-400-5099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number26NJ15101400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: