Provider Demographics
NPI:1841203775
Name:LOGAN, JOSEPH J (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:LOGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WESTCHESTER AVE
Mailing Address - Street 2:SUITE N-511
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-1354
Mailing Address - Country:US
Mailing Address - Phone:914-428-5454
Mailing Address - Fax:914-428-5460
Practice Address - Street 1:55 PALMER AVE
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3403
Practice Address - Country:US
Practice Address - Phone:908-358-9319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236696207L00000X
NJ25MB08581500207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1078533OtherAETNA - HMO
NY1503S2OtherEMPIRE BC/BS
NY4925799OtherCIGNA
NYP3631260OtherOXFORD HEALTH PLAN
TINOtherHORIZION HEALTHCARE
NY2581116OtherUNITED HEALTHCARE
NY7173769OtherAETNA - PPO
NY4C8142OtherHEALTH NET
TINOtherMULTIPLAN
NYPENDING 1ST CLAIMOtherRAILROAD MEDICARE
NY7173769OtherAETNA - PPO
NY1503S2OtherEMPIRE BC/BS