Provider Demographics
NPI:1578696894
Name:SISKIN, JOSHUA MICHAEL
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MICHAEL
Last Name:SISKIN
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 1:4458 TYRONE AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2627
Mailing Address - Country:US
Mailing Address - Phone:818-783-7483
Mailing Address - Fax:
Practice Address - Street 1:14640 VICTORY BLVD
Practice Address - Street 2:#100
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1623
Practice Address - Country:US
Practice Address - Phone:818-374-6901
Practice Address - Fax:818-374-6908
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner