Provider Demographics
NPI:1790760643
Name:JOSEPH, NIRMAL JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:NIRMAL
Middle Name:JAY
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:PO BOX 840207
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33084-2207
Mailing Address - Country:US
Mailing Address - Phone:305-595-4510
Mailing Address - Fax:
Practice Address - Street 1:9370 SUNSET DR
Practice Address - Street 2:SUITE A-250
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5431
Practice Address - Country:US
Practice Address - Phone:305-595-4510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91539207L00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50228OtherBCBS
FL271840500Medicaid