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General NPI Number Information
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NPI Number | 1578563334
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Entity Type | Individual
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Provider Name | JOSEPH WILLIAM FANELLE MD
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Gender | Male
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Dates
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Enumeration Date | 07/22/2005
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 1505 W SHERMAN AVE
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City | VINELAND
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State | NJ
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Zip | 08360-7059
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Country | US
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Telephone | 568-641-7920
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Fax | 856-641-8689
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Provider Business Mailing Address
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Address Line | 184 FIELD LOOP
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City | GLASSBORO
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State | NJ
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Zip | 08028-3292
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Country | US
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Telephone | 609-501-7489
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Fax | 856-575-5012
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 25MA05181300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | MD042008E
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License Number State | PA
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