Provider Demographics
NPI:1578553269
Name:STEIN, JOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:STEIN
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 1:180 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE 199
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3722
Mailing Address - Country:US
Mailing Address - Phone:212-305-4818
Mailing Address - Fax:212-342-3138
Practice Address - Street 1:180 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE 199
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3722
Practice Address - Country:US
Practice Address - Phone:212-305-4818
Practice Address - Fax:212-342-3138
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75663207R00000X, 208100000X
NY170605208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ12195OtherBCBS MA
MA075663OtherTUFTS HEALTH PLAN
MA3090451Medicaid
MA075663OtherTUFTS HEALTH PLAN
MAJ12195OtherBCBS MA
F22529Medicare UPIN