Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 25MB10509200 | NJ |
NPI | 1003158247 |
---|---|
Provider Name | Dr. Joseph L Derose |
First Address | Voorhees, NJ 08043-3715 |
Second Address | Turnersville, NJ 08012-2056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2013 |
Last Update Date | 24/09/2019 |