Provider Demographics
NPI:1114237047
Name:RICHARD S JOSEPH MD PC
Entity Type:Organization
Organization Name:RICHARD S JOSEPH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SAUL
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-549-6969
Mailing Address - Street 1:205 E MAIN ST
Mailing Address - Street 2:SUITE1-4
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2923
Mailing Address - Country:US
Mailing Address - Phone:631-549-6969
Mailing Address - Fax:631-421-0333
Practice Address - Street 1:205 E MAIN ST
Practice Address - Street 2:SUITE1-4
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2923
Practice Address - Country:US
Practice Address - Phone:631-549-6969
Practice Address - Fax:631-421-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091447-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY091447-3IOtherNY STATE WORKMANS COMP
NY01544518Medicaid
060067802OtherRAILROAD MEDICARE
NY01544518Medicaid
NYA100034172Medicare PIN