Provider Demographics
NPI:1104589118
Name:JOYFUL HEALTHCARE LLC
Entity type:Organization
Organization Name:JOYFUL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:ODEIDA
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-936-9660
Mailing Address - Street 1:29 SANDERS PL
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-1211
Mailing Address - Country:US
Mailing Address - Phone:201-936-9660
Mailing Address - Fax:478-202-9392
Practice Address - Street 1:12-15 BROADWAY STE 2A
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2031
Practice Address - Country:US
Practice Address - Phone:201-266-5365
Practice Address - Fax:478-202-9392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-16
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0825115Medicaid