Provider Demographics
NPI:1811911225
Name:JANNONE, JOEL PETER (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:PETER
Last Name:JANNONE
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 1:801 LACEY ROAD
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-1301
Mailing Address - Country:US
Mailing Address - Phone:609-242-0040
Mailing Address - Fax:609-242-1019
Practice Address - Street 1:801 LACEY ROAD
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1301
Practice Address - Country:US
Practice Address - Phone:609-242-0040
Practice Address - Fax:609-242-1019
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03643200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1332104Medicaid
NJ1332104Medicaid
C52705Medicare UPIN