Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | P338304-1 | NY |
NPI | 1205265030 |
---|---|
Provider Name | Jeana Joseph |
First Address | New York, NY 10065-5605 |
Second Address | New York, NY 10065-5605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2013 |
Last Update Date | 03/06/2014 |