Provider Demographics
NPI:1467435271
Name:JOSEPH, ANTONIO JR (MD,)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:JOSEPH
Suffix:JR
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 516
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11582-0516
Mailing Address - Country:US
Mailing Address - Phone:516-285-2850
Mailing Address - Fax:516-285-0038
Practice Address - Street 1:22414 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2023
Practice Address - Country:US
Practice Address - Phone:718-949-6433
Practice Address - Fax:718-949-0331
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176371207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01305348Medicaid
NY00G361Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NYE97215Medicare UPIN