Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 306155 | NY |
Y | 111NI0900X | Internist | 306155 | NY |
NPI | 1003340068 |
---|---|
Provider Name | Joe Joseph |
First Address | Lagrangeville, NY 12540-5144 |
Second Address | Poughkeepsie, NY 12601-3947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2017 |
Last Update Date | 28/07/2020 |