Provider Demographics
NPI:1174576052
Name:MUSICANT, JOEL M (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:M
Last Name:MUSICANT
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 1:475 ROUTE 70
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5897
Mailing Address - Country:US
Mailing Address - Phone:732-886-1007
Mailing Address - Fax:732-886-0807
Practice Address - Street 1:475 ROUTE 70
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5897
Practice Address - Country:US
Practice Address - Phone:732-886-1007
Practice Address - Fax:732-886-0807
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06084300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110057519OtherRAILROAD MEDICARE
NJF82218Medicare UPIN
NJMU040350Medicare ID - Type Unspecified