Provider Demographics
NPI:1568693687
Name:JOSEPH, JEAN E
Entity Type:Individual
Prefix:MR
First Name:JEAN
Middle Name:E
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W 95TH ST
Mailing Address - Street 2:3H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 W 95TH ST
Practice Address - Street 2:3H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6331
Practice Address - Country:US
Practice Address - Phone:917-776-6518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE008381225200000X
NY006851225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant