Provider Demographics
NPI:1073777231
Name:DEJOSEPH, MAURA E (DO)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:E
Last Name:DEJOSEPH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6100
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-0099
Mailing Address - Country:US
Mailing Address - Phone:631-853-5555
Mailing Address - Fax:
Practice Address - Street 1:725 VETERANS MEMORIAL HIGHWAY
Practice Address - Street 2:FORENSIC SCIENCES BLDG #487
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-0099
Practice Address - Country:US
Practice Address - Phone:631-853-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244124207ZF0201X
MA236776207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology