Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 19215 | PR |
NPI | 1043669021 |
---|---|
Provider Name | Jojo Joseph |
First Address | Suffern, NY 10901-7735 |
Second Address | Carolina, PR 00987 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2016 |
Last Update Date | 13/11/2018 |