Provider Demographics
NPI:1285615989
Name:KASPARECK, JOSEPH M JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:KASPARECK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2017
Mailing Address - Country:US
Mailing Address - Phone:908-725-6225
Mailing Address - Fax:908-218-0802
Practice Address - Street 1:56 UNION AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2017
Practice Address - Country:US
Practice Address - Phone:908-725-6225
Practice Address - Fax:908-218-0802
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04084400207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1574302Medicaid
P2111070OtherOXFORD
4332108OtherAETNA
452718Medicare ID - Type Unspecified
C55366Medicare UPIN