Provider Demographics
NPI:1588719587
Name:MOSQUERA, JOSEPH L (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:MOSQUERA
Suffix:
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 1:137 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-1712
Mailing Address - Country:US
Mailing Address - Phone:603-502-5959
Mailing Address - Fax:
Practice Address - Street 1:137 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1712
Practice Address - Country:US
Practice Address - Phone:603-502-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04078800173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
22-3148983OtherEIN
456405Medicare ID - Type Unspecified
C55809Medicare UPIN