Provider Demographics
NPI:1609951136
Name:JOSEPH, WAYNE PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:PATRICK
Last Name:JOSEPH
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 1:3059 EDSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-3225
Mailing Address - Country:US
Mailing Address - Phone:718-791-3924
Mailing Address - Fax:718-379-1511
Practice Address - Street 1:2310 EASTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469
Practice Address - Country:US
Practice Address - Phone:718-519-6340
Practice Address - Fax:718-519-7898
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2119400Medicaid
NY1D5301Medicare ID - Type Unspecified
NY2119400Medicaid