Provider Demographics
NPI:1154323897
Name:JOSEPH MOTTA MD PC
Entity Type:Organization
Organization Name:JOSEPH MOTTA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-370-1400
Mailing Address - Street 1:1200 SOUTH AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3413
Mailing Address - Country:US
Mailing Address - Phone:718-370-1400
Mailing Address - Fax:718-370-9290
Practice Address - Street 1:1200 SOUTH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3413
Practice Address - Country:US
Practice Address - Phone:718-370-1400
Practice Address - Fax:718-370-9290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194905208600000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01817963Medicaid
NY01817963Medicaid
NY56T391Medicare ID - Type Unspecified