Provider Demographics
NPI:1437352317
Name:POTASH, JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:POTASH
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 1:161 EDGEHILL RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1611
Mailing Address - Country:US
Mailing Address - Phone:315-446-9197
Mailing Address - Fax:
Practice Address - Street 1:249 ROUTE 11A
Practice Address - Street 2:
Practice Address - City:NEDRON
Practice Address - State:NY
Practice Address - Zip Code:13120
Practice Address - Country:US
Practice Address - Phone:315-469-6449
Practice Address - Fax:315-469-0593
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00482417Medicare ID - Type Unspecified
54689BMedicare ID - Type Unspecified