Provider Demographics
NPI:1851411573
Name:JOSEPH, HAROLD THIBOU (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:THIBOU
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 1:12 NEW LANE
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-3322
Mailing Address - Country:US
Mailing Address - Phone:631-451-0200
Mailing Address - Fax:631-716-1984
Practice Address - Street 1:12 NEW LANE
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-3322
Practice Address - Country:US
Practice Address - Phone:631-451-0200
Practice Address - Fax:631-716-1984
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096052207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00160090Medicaid
NY00160090Medicaid
NY539101Medicare PIN