Basic Information
| Provider Information | |||||||||
| NPI: | 1760429369 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FALLON | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 42 E LAUREL RD STE 3100 | ||||||||
| Address2: | |||||||||
| City: | STRATFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080841354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565667070 | ||||||||
| FaxNumber: | 8565665079 | ||||||||
| Practice Location | |||||||||
| Address1: | 42 E LAUREL RD STE 3100 | ||||||||
| Address2: | |||||||||
| City: | STRATFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080841354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565667070 | ||||||||
| FaxNumber: | 8565665079 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 03/29/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 25MA03990700 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 472225 | 01 | NJ | RAILROAD MEDICARE | OTHER | 1737007 | 05 | NJ | MEDICAID | 3301303 | 05 | NJ | MEDICAID | 425130AED | 01 | NJ | MEDICARE PIN | OTHER |