Provider Demographics
NPI:1205839495
Name:CHRISTIANA, JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:CHRISTIANA
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:PO BOX 5801
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-5801
Mailing Address - Country:US
Mailing Address - Phone:914-593-7880
Mailing Address - Fax:914-593-7881
Practice Address - Street 1:55 GRAND ST
Practice Address - Street 2:STE 106
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3933
Practice Address - Country:US
Practice Address - Phone:845-339-8700
Practice Address - Fax:914-593-7881
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207897207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY400P0X0942OtherPTAN
NY02147515Medicaid
NY400P032241OtherPTAN
NY060063770OtherRAIL ROAD MEDICARE
NY400P033642OtherPTAN
NY400P0X0943OtherPTAN
NY400P01Medicare ID - Type Unspecified
NY400P0X0943OtherPTAN