Provider Demographics
NPI:1467452805
Name:JOSEPH, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:205 E MAIN ST
Mailing Address - Street 2:SUITE 1-4
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2923
Mailing Address - Country:US
Mailing Address - Phone:631-549-6969
Mailing Address - Fax:631-421-0333
Practice Address - Street 1:205 E MAIN ST
Practice Address - Street 2:SUITE1-4
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2923
Practice Address - Country:US
Practice Address - Phone:631-549-6969
Practice Address - Fax:631-421-0333
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091447207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01544518Medicaid
C10920Medicare UPIN
NY01544518Medicaid