=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710144639
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH CIRELLO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2008
-----------------------------------------------------
Last Update Date | 12/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 E CATHERINE ST SUITE 250
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18337-1347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-409-1162
-----------------------------------------------------
Fax | 570-409-1165
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 416457
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02241-0645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-656-6280
-----------------------------------------------------
Fax | 973-290-7495
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD438202
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 25MA08473600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------