Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 303563 | NY |
Y | 207Q00000X | Family Doctor | 303563 | NY |
NPI | 1669835724 |
---|---|
Provider Name | Joshua Potter |
First Address | Southampton, NY 11968-4973 |
Second Address | Westhampton Beach, NY 11978-1733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2016 |
Last Update Date | 28/08/2020 |