Provider Demographics
NPI:1598082562
Name:JOACHIM, SERGE J
Entity Type:Individual
Prefix:MR
First Name:SERGE
Middle Name:J
Last Name:JOACHIM
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 1:9347 210TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1053
Mailing Address - Country:US
Mailing Address - Phone:917-775-7680
Mailing Address - Fax:
Practice Address - Street 1:9347 210TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11428-1053
Practice Address - Country:US
Practice Address - Phone:917-775-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY735194247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist