Provider Demographics
NPI:1396046074
Name:BISHOP, JOSIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSIE
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 BOGART AVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3320
Mailing Address - Country:US
Mailing Address - Phone:917-359-5162
Mailing Address - Fax:
Practice Address - Street 1:220 S SERVICE RD STE 16
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2131
Practice Address - Country:US
Practice Address - Phone:917-359-5162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018650-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist