Provider Demographics
NPI:1669825477
Name:JOE, CASEY (MD)
Entity Type:Individual
Prefix:MS
First Name:CASEY
Middle Name:
Last Name:JOE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1650 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7697
Mailing Address - Country:US
Mailing Address - Phone:718-960-1216
Mailing Address - Fax:718-960-1370
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7697
Practice Address - Country:US
Practice Address - Phone:718-960-1216
Practice Address - Fax:718-960-1370
Is Sole Proprietor?:No
Enumeration Date:2016-07-16
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME161517208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery