Provider Demographics
NPI:1598482291
Name:BROOKS, JOSEPH (AGNPC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:AGNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 DASHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-4508
Mailing Address - Country:US
Mailing Address - Phone:845-443-1120
Mailing Address - Fax:
Practice Address - Street 1:60 MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2990
Practice Address - Country:US
Practice Address - Phone:845-765-4990
Practice Address - Fax:845-765-4989
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF310701-01363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner