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General NPI Number Information
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NPI Number | 1467869727
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Entity Type | Individual
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Provider Name | JERRY JOSEPH MD
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Gender | Male
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Dates
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Enumeration Date | 07/18/2014
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Last Update Date | 02/02/2022
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Provider Practice Location Address
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Address Line | 851 FRANKLIN LAKE RD STE 105
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City | FRANKLIN LAKES
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State | NJ
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Zip | 07417
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Country | US
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Telephone | 201-904-2230
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Fax | 201-904-2232
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Provider Business Mailing Address
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Address Line | 851 FRANKLIN LAKE RD STE 105
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City | FRANKLIN LAKES
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State | NJ
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Zip | 07417-2267
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Country | US
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Telephone | 201-904-2230
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Fax | 201-904-2232
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 287231
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License Number State | NY
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