Provider Demographics
NPI:1578737839
Name:JOSEPH, MIGUEL (LPN)
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E 18TH ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3743
Mailing Address - Country:US
Mailing Address - Phone:917-432-7126
Mailing Address - Fax:
Practice Address - Street 1:100 E 18TH ST APT 4B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3743
Practice Address - Country:US
Practice Address - Phone:917-432-7126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286552-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse