Provider Demographics
NPI:1043295991
Name:JOSEPH, PATRICIA K (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:K
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 NORTH MIDLAND AVE.,
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960
Mailing Address - Country:US
Mailing Address - Phone:201-567-5111
Mailing Address - Fax:201-541-4005
Practice Address - Street 1:160 NORTH MIDLAND AVE.,
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960
Practice Address - Country:US
Practice Address - Phone:201-567-5111
Practice Address - Fax:201-541-4005
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA39957174400000X
NY143006-1174400000X
NY#143006208600000X
NJ#MA39957208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJJ0502888Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER