Basic Information
| Provider Information | |||||||||
| NPI: | 1063628360 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESIPIO | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | PETER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 FEDERAL ST # 200 | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563564924 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 501 FELLOWSHIP RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080543419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8569633572 | ||||||||
| FaxNumber: | 8563389211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 04/17/2019 | ||||||||
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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 | 207RG0100X | 25MA08241400 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 45067 | 01 | UNIVERSITY HEALTHPLAN | OTHER | 60036692 | 01 | HORIZON NJ HEALTH | OTHER | 010045951 | 01 | AMERICHOICE | OTHER | 1979176 | 01 | PA | BLUE SHIELD | OTHER | 4493315 | 01 | CIGNA | OTHER | 1635008 | 01 | DE | AETNA | OTHER | 0139475 | 05 | NJ | MEDICAID | 1635399 | 01 | NJ | AETNA | OTHER | 2621382000 | 01 | NJ | AMERIHEALTH GRP# | OTHER | 235015400 | 01 | DE | AMERIHEALTH DELAWARE GRP# | OTHER | P3821723 | 01 | OXFORD | OTHER | 2858174000 | 01 | AMERIHEALTH HMO, KEYSTONE, IBC | OTHER | P00414121 | 01 | NJ | RR MEDICARE | OTHER |