Provider Demographics
NPI:1902088784
Name:ODELLI, JOSEPH CHARLES JR
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:CHARLES
Last Name:ODELLI
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 ANTHONY AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7104
Mailing Address - Country:US
Mailing Address - Phone:732-832-9804
Mailing Address - Fax:
Practice Address - Street 1:730 LACEY RD
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1300
Practice Address - Country:US
Practice Address - Phone:732-255-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant