Provider Demographics
NPI:1619379450
Name:WHITBECK, JOANNA (PA)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:WHITBECK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:MASTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1910 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-6027
Mailing Address - Country:US
Mailing Address - Phone:845-454-0120
Mailing Address - Fax:845-790-2131
Practice Address - Street 1:1910 SOUTH RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-6027
Practice Address - Country:US
Practice Address - Phone:845-454-0120
Practice Address - Fax:845-790-2131
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17965363A00000X
NY017965363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400111529Medicare PIN