Provider Demographics
NPI:1912103730
Name:JOYCE M. FATATO, D.C., LLC
Entity type:Organization
Organization Name:JOYCE M. FATATO, D.C., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FATATO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-566-9800
Mailing Address - Street 1:235 GIBBSBORO RD
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-4134
Mailing Address - Country:US
Mailing Address - Phone:856-566-9800
Mailing Address - Fax:856-566-1323
Practice Address - Street 1:235 GIBBSBORO RD
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-4134
Practice Address - Country:US
Practice Address - Phone:856-566-9800
Practice Address - Fax:856-566-1323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC00489300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ098545Medicare ID - Type Unspecified
NJU78981Medicare UPIN