Provider Demographics
NPI:1225592355
Name:JOSHUA, FAUSTINE BIANCA
Entity Type:Individual
Prefix:MS
First Name:FAUSTINE
Middle Name:BIANCA
Last Name:JOSHUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 PUTNEY RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1818
Mailing Address - Country:US
Mailing Address - Phone:917-208-7119
Mailing Address - Fax:
Practice Address - Street 1:1626 PUTNEY RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-1818
Practice Address - Country:US
Practice Address - Phone:917-208-7119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123550174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist