Healthcare Provider Details

I. General information

NPI: 1679597249
Provider Name (Legal Business Name): JAY PHILIP JOSEPH D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

992 MANTUA PIKE STE 304
WOODBURY HEIGHTS NJ
08097-1249
US

IV. Provider business mailing address

992 MANTUA PIKE STE 304
WOODBURY HEIGHTS NJ
08097-1249
US

V. Phone/Fax

Practice location:
  • Phone: 856-853-8900
  • Fax: 856-853-0268
Mailing address:
  • Phone: 856-853-8900
  • Fax: 856-853-0268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI01057500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: