Provider Demographics
NPI:1508896507
Name:KING, JOEL H (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:H
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E MIDDLE COUNTRY RD STE 310
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2814
Mailing Address - Country:US
Mailing Address - Phone:631-265-1622
Mailing Address - Fax:631-265-3042
Practice Address - Street 1:222 E MIDDLE COUNTRY RD STE 310
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2814
Practice Address - Country:US
Practice Address - Phone:631-265-1622
Practice Address - Fax:631-265-3042
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1257932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY125793-OBOtherWORKERS COMP
NY3034436OtherOXFORD
NY3034436OtherOXFORD
NY312631Medicare PIN