Provider Demographics
NPI:1114476603
Name:JOAQUIN, YSMAEL ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:YSMAEL
Middle Name:ANTONIO
Last Name:JOAQUIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CARLSTADT
Mailing Address - State:NJ
Mailing Address - Zip Code:07072-1438
Mailing Address - Country:US
Mailing Address - Phone:201-213-1931
Mailing Address - Fax:
Practice Address - Street 1:150 PARK ROW
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1704
Practice Address - Country:US
Practice Address - Phone:646-836-6300
Practice Address - Fax:646-836-6481
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant