Provider Demographics
NPI:1528022647
Name:SOCOLOW, JOSHUA A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:A
Last Name:SOCOLOW
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 1:50 MURRAY ST
Mailing Address - Street 2:APT 302
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-2252
Mailing Address - Country:US
Mailing Address - Phone:708-856-2192
Mailing Address - Fax:
Practice Address - Street 1:506 6TH ST
Practice Address - Street 2:DEPT OF CARDIOLOGY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3609
Practice Address - Country:US
Practice Address - Phone:718-780-5037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110741207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02985757Medicaid
IL01621208OtherBLUE CROSS BLUE SHIELD
ILP00110166OtherRAILROAD MEDICARE COOK
IL036110741Medicaid
ILP00227169OtherRAILROAD MEDICARE WILL
IL416810OtherMEDICARE GROUP
IL236551OtherMEDICARE GROUP
IL236550OtherMEDICARE GROUP
IL236551OtherMEDICARE GROUP
ILP00227169OtherRAILROAD MEDICARE WILL
I05826Medicare UPIN
IL416810OtherMEDICARE GROUP