Provider Demographics
NPI:1164838298
Name:JOSEPH, LIJO
Entity Type:Individual
Prefix:
First Name:LIJO
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 EASTCHESTER RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2252
Mailing Address - Country:US
Mailing Address - Phone:718-794-0600
Mailing Address - Fax:718-794-9899
Practice Address - Street 1:2008 EASTCHESTER RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2252
Practice Address - Country:US
Practice Address - Phone:718-794-0600
Practice Address - Fax:718-794-9899
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034206225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist