Provider Demographics
NPI:1669674222
Name:BLACK, JOY LYNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOY
Middle Name:LYNETTE
Last Name:BLACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:57 OVERHILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2936
Mailing Address - Country:US
Mailing Address - Phone:845-343-8962
Mailing Address - Fax:845-343-9088
Practice Address - Street 1:825 ROUTE 211 E
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-1443
Practice Address - Country:US
Practice Address - Phone:845-692-8338
Practice Address - Fax:845-692-6177
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186221-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY91F281Medicare ID - Type Unspecified
NYE89679Medicare UPIN