Provider Demographics
NPI:1073515847
Name:PODHORZER, JOSEPH RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RICHARD
Last Name:PODHORZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:167 SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11509-1633
Mailing Address - Country:US
Mailing Address - Phone:718-645-2201
Mailing Address - Fax:718-645-2207
Practice Address - Street 1:2025 KINGS HWY SECOND FLOOR
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1173
Practice Address - Country:US
Practice Address - Phone:718-645-2231
Practice Address - Fax:718-663-2933
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2021-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY193410207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01659778Medicaid
NYF99701Medicare UPIN
NY123373Medicare ID - Type Unspecified