Provider Demographics
NPI:1053354357
Name:ORDILLE, JOSEPH D (DO)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:D
Last Name:ORDILLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:105 MANHEIM AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302
Mailing Address - Country:US
Mailing Address - Phone:856-455-2700
Mailing Address - Fax:856-455-7051
Practice Address - Street 1:105 MANHEIM AVE
Practice Address - Street 2:STE 1
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-2139
Practice Address - Country:US
Practice Address - Phone:856-455-2700
Practice Address - Fax:856-455-7051
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ07343900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8795100Medicaid
NJ8795100Medicaid
F76181Medicare UPIN