Provider Demographics
NPI:1053351569
Name:CAMPBELL, JOSEPH V (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:V
Last Name:CAMPBELL
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-0068
Mailing Address - Country:US
Mailing Address - Phone:973-373-1875
Mailing Address - Fax:973-373-9005
Practice Address - Street 1:1057 SANFORD AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-1946
Practice Address - Country:US
Practice Address - Phone:973-373-1875
Practice Address - Fax:973-373-9005
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ,A59366174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7291108Medicaid
NJ480956Medicare PIN
NJ7291108Medicaid