Provider Demographics
NPI:1376562132
Name:CHEMTOB, JOSEF (MD)
Entity Type:Individual
Prefix:
First Name:JOSEF
Middle Name:
Last Name:CHEMTOB
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 429
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-0429
Mailing Address - Country:US
Mailing Address - Phone:845-342-7615
Mailing Address - Fax:845-342-7617
Practice Address - Street 1:60 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4133
Practice Address - Country:US
Practice Address - Phone:845-342-7615
Practice Address - Fax:845-342-7617
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-11709207R00000X
NY240675207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJC02675S20OtherBCBS
NY02785344Medicaid
NY240675OtherLICENSE #
P00353468Medicare PIN
JC0257ST10Medicare PIN
NYA400011044Medicare PIN