MEDICARE: DR. JOSEPH J MINISSALE JR. D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	DO2986	ME
2	207RG0100X	Gastroenterology Physician	OS007619L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366441354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH J MINISSALE JR. D.O.

Provider Business Mailing Address
First Line	:	701 OSTRUM ST STE 201
Second Line	:
City	:	FOUNTAIN HILL
State	:	PA
Zip	:	18015-1152
Country	:	US
Telephone Number	:	484-526-6545
Fax Number	:	484-526-6546

Provider Business Practice Location Address
First Line	:	4 GLEN COVE DR
Second Line	:
City	:	ROCKPORT
State	:	ME
Zip	:	04856-4235
Country	:	US
Telephone Number	:	207-301-5790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	12/28/2021

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