Healthcare Provider Details

I. General information

NPI: 1003874397
Provider Name (Legal Business Name): JOSEPH M FOLLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 BLOOMFIELD AVE SUITE 205
WEST CALDWELL NJ
07006
US

IV. Provider business mailing address

1129 BLOOMFIELD AVE SUITE 205
WEST CALDWELL NJ
07006-7127
US

V. Phone/Fax

Practice location:
  • Phone: 973-227-2272
  • Fax: 973-227-2279
Mailing address:
  • Phone: 973-227-2272
  • Fax: 973-227-2279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07356100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: